Dry Eye Risk Assessment
Please print this page and circle the appropriate response.
|
0
|
1
|
2
|
|
| 1. Age |
under 25
(0) |
25-45
(1) |
over 45
(2) |
| 2. Have you ever had drops prescribed or other treatment for dry eyes? |
No
(0) |
Uncertain
(1) |
Yes
(2) |
| 3. Do you ever experience any of the following eye symptoms: Soreness Scratchiness, Dryness, Grittiness, Burning? |
No
(0) |
Uncertain
(1) |
Yes
(2) |
| 4. How often do your eyes experience those symptoms? |
Never
(0) |
Often
(1) |
Constantly
(2) |
| 5. Do you regard your eyes as being unusually sensitive to cigarette smoke, smog, air conditioning or central heating? |
No
(0) |
Sometimes
(1) |
Yes
(2) |
| 6. Do your eyes easily become very red and irritated when swimming in chlorinated fresh water? |
No/Not Applicable
(0) |
Sometimes
(1) |
Yes
(2) |
| 7. Do you take any of these medications: antihistamine tablets, diuretics (fluid tablets), sleeping tablets, tranquilizers, oral contraceptives, medication for duodenal ulcer (or digestive problems), or for high blood pressure medication? |
No
(0) |
Yes
(1) |
|
| 8. Do you suffer from arthritis? |
No
(0) |
Uncertain
(1) |
Yes
(2) |
| 9. Are you known to sleep with your eyes partly open? |
No
(0) |
Uncertain
(1) |
Yes
(2) |
| 10. Do you have eye irritation as you wake from sleep? |
No
(0) |
Uncertain
(1) |
Yes
(2) |
Now add up the numbers in each column
1-2 = LOWEST RISK
3+ = HIGHER RISK
4+ = SIGNIFICANT RISK OF HAVING DRY EYE
| Answers |
| 1. Older patients have a much higher incidence of dry eye and corneal surface disorders. As many as 40% of elderly patients suffer some form of surface disorder. |
| 2. Dry eye is a chronic condition that is exacerbated by environmental conditions such as humidity, exposure drying, lack of sleep, wind, and air conditioning, allergy antigens such as pollens and grasses and hormonal changes. Because the underlying problems tend to be chronic in nature if you have been prescribed drops for dry eye then you have a high risk of symptoms. |
| 3. Soreness, scratchiness, dryness, grittiness and burning are all symptoms of corneal surface disorder (dry eye). Also tearing is a frequent symptom. Many patients have difficulty understanding that excess tearing can be caused by dry eye. The underlying cause of the tearing in dry eye is reflex tearing due to irritation of the corneal surface. The patient may still experience a reduction in basal tears (the basic level of secretion of tears) yet may have adequate reflex tears. Reflex tears help flush the eye when it is irritated, basal tears help lubricate the eye under normal circumstances. |
| 4. The more symptomatic a patient is the more likely he or she has a dry eye condition that requires treatment. Almost everyone's eyes can be irritated at one time or another, but frequent irritation needs to be addressed. |
| 5. Dry eyes are more sensitive to dry environments, allergens, and irritants. Corneal surface disorders that are sub-clinical can often become clinically present with environmental changes. |
| 6. Chlorinated fresh water helps wash away the protective lipid layer of the cornea. Patients with dry eye or surface disorders have trouble re-establishing a normal corneal tear film after swimming. |
| 7. Antihistamines along with sleeping medication, digestive medication, tranquilizers, anti-hypertensives and other types of medication can cause a reduction in tear output. |
| 8. Patients with arthritis have much higher incidences of connective tissue disorders. The mucous membrane surrounding the eye is a connective tissue and it's lubrication or lack of is often associated with arthritis. |
| 9. Often patients will have improper lid closure when sleeping. The small area exposed when the lids do not close fully is subject to drying. These patients often experience discomfort or gritty eyes upon awakening. |
| 10. Some forms of corneal basement membrane disorders affect the way that the outer layer of cells sticks to the cornea. These disorders along with improper lid closure create eye irritation upon awakening. |
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