Have you experienced any of the following symptoms?

Sensitivity to light*

Gritty or scratchy sensation*

Burning or stinging*

Blurred/unclear visions*

Tearing/watering*

Pain/burning during the night or upon awakening in the morning*

Do any of the symptoms above get worse after using a computer or cell phone?*

Do your eye symptoms get in the way of your work or daily activities?*

How Accurate is this statement, “Contact lenses are uncomfortable for me”?*

How often are you using eye drops and other means for short-term relief?*

Add your name, phone number and email address to see your results:

Name*

First Last

Phone*

Email

New or returning patient?*

Do you have dry eyes?

Midwest Dry Eye Center