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Ocular Health & Aesthetics Questionnaire

Name
MM slash DD slash YYYY
Ocular Comfort & Health
Please check all symptoms experienced since the last visit
How often do you use artificial tears throughout the day?
Can you wear your contacts comfortable as long as you would like?
How many hours are you on the computer?
Do your eyes feel drier at the beginning or the end of the day?
Overall Health
Check any of the surgeries that you have had:
List Current Medications:
Check any of the treatments that you have tried in the past:
Ocular Aesthetics
Please check all symptoms experienced

Dry Eye Questionnaire

Please answer the following questions by checking the box that best represents your answer. Select only one answer per question.
  • 1. Do you experience EYE DISCOMFORT?

  • 2. Do you experience EYE DRYNESS?

  • 3. Do you have WATERY EYES?

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DRY EYE TREATMENT AT Midwest Dry Eye Center


During a dry eye examination at our eye care center in Long Grove, we will recommend dry eye treatments tailored to treat your symptoms and provide lasting relief. We are dedicated to ensuring that you enjoy clear and comfortable vision so that you can live your best life. Whether you have chronic dry eye or a recent dry eye issue, we have the right treatment plan for you.

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Long Grove Dry Eye Treatments

 

Midwest Dry Eye Center has some of the most cutting-edge and advanced technologies to quickly and effectively test for dry eye syndrome.

Among our treatments for dry eye syndrome, the most typical treatments start with medicated eye drops, anti-inflammatory drops, or a heated compress. Occasionally, tiny devices called punctal plugs are inserted into the eye’s tear duct to prevent moisture from draining out of the eye. These plugs increase the moisture level for long-term relief.

Let our optometric team and the talented, experienced staff help get you started on the path to real long-term relief from dry eye.


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