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 type of SYMPTOMS and when they occur:

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

Burning or Watering

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

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

Please list your symptoms and any other additional comments