Dry Eye Assessment

Dry Eye Assessment


For the Standardized Patient Evaluation of Eye Dryness (SPEED) Questionnaire, please answer the following questions by checking the box that best represents your answer. Select only one answer per question.

Report the SYMPTOMS of your symptoms using the rating list below:
(0 = Never, 1 = Sometimes, 2 = Often, 3 = Constant)

Dryness, Grittiness, or Scratchiness

Soreness or Irritation

Burning or Watering

Eye Fatigue

Report the FREQUENCY of your symptoms using the rating list below:
(0 = Never, 1 = Sometimes, 2 = Often, 3 = Constant)

Dryness, Grittiness, or Scratchiness

Soreness or Irritation

Burning or Watering

Eye Fatigue

Report the SEVERITY of your symptoms using the rating list below:
(0 = No Problems, 1 = Tolerable, 2 = Uncomfortable, 3 = Bothersome, 4 = Intolerable)

Dryness, Grittiness or Scratchiness

Soreness or Irritation

Burning or Watering

Eye Fatigue

Do you use eye drops for lubrication? If yes, how often?

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