Questions about Eye Discomfort:

1. During a typical day in the past month, how often did your eyes feel discomfort?

---0 Never1 Rarely2 Sometimes3 Frequently4 Constantly

2. When you felt discomfort, how often did it feel intense?

---0 Never have it1 Not at All Intense2 Somewhat Intense3 Frequently4 Constantly5 Very Intense

Questions about Eye Dryness:

3. During a typical month, how often do your eyes feel dry?

---0 Never1 Rarely2 Sometimes3 Frequently4 Constantly

4. How often is the dryness most intense at the end of the day/within two hours of going to sleep?

---0 Never have it1 Not at All Intense2 Somewhat Intense3 Frequently4 Constantly5 Very Intense

Questions about Watery Eyes:

5. During a typical day in the past month, how often did your eyes look or feel excessively watery?

---0 Never1 Rarely2 Sometimes3 Frequently4 Constantly

Contact Information

What is your name?

What is your phone number?

What is your email address?