Dry Eye Questionnaire

Standardized Patient Evaluation of Eye Dryness (SPEED) Questionnaire

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.

1. Report the type of SYMPTOMS you experience and when they occur:

Dryness, Grittiness or Scratchiness*

Soreness or Irritation*

Burning or Watering*

Eye Fatigue*

2. Report the FREQUENCY of your symptoms using the rating list below:*

Dryness, Grittiness or Scratchiness

Soreness or Irritation

Burning or Watering

Eye Fatigue

3. Report the SEVERITY of your symptoms using the rating list below:*

Dryness, Grittiness or Scratchiness

Soreness or Irritation

Burning or Watering

Eye Fatigue

4. Do you use eye drops for lubrication?​​​​​​​

If using drops, how often?

First Name*

Last Name

Date of Birth:*

Email*

Click to see your eye dryness (speed) score.

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