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Dry Eye Assessment and Management Study ELIGIBILITY OCULAR EVALUATION FORM EO (032.2 05 26/15-Page 1 of 13 ID. No.: Alpha Code: Visit: BEFORE COMPLETING THE OCULAR EXAMINATION, YOU MUST BE ABLE TO
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How to fill out dry eye assessment and

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How to fill out dry eye assessment:

01
Start by carefully reading the instructions provided with the assessment form. Make sure you understand what information is required and how to correctly fill it out.
02
Begin with the basic personal details section, including your name, age, gender, and contact information. This will help identify and track your assessment throughout the process.
03
Move on to the medical history section. Provide accurate information about any previous eye conditions, surgeries, or treatments you have undergone. Include details of any medications you are currently taking that may affect your eye health.
04
Answer the questions related to your symptoms. Be honest and specific about the dry eye symptoms you are experiencing, such as burning, itching, redness, or blurry vision. Include any triggers or factors that worsen or alleviate your symptoms.
05
Proceed to the lifestyle and environmental factors section. Here, you may be asked about your occupation, hobbies, and any environmental conditions that may contribute to your dry eye symptoms. This information helps in identifying potential causes and suggesting appropriate management strategies.
06
Complete any additional sections or questionnaires included in the assessment form. This may include questions about your quality of life, impact of dry eyes on daily activities, or your satisfaction with previous treatments tried.
07
Review your answers once you have completed the form. Ensure all sections are filled out accurately and honestly. If you have any doubts or questions, consult with your eye care professional for clarification.
08
Submit the filled-out dry eye assessment form to your eye care professional or the designated recipient as instructed.

Who needs dry eye assessment:

01
Individuals experiencing symptoms of dry eye, such as a gritty or sandy sensation, burning or stinging, redness or irritation, or excessive tearing.
02
People with a history of eye conditions, surgeries, or treatments that may potentially affect tear production or quality.
03
Those who have been diagnosed with certain medical conditions or are taking medications known to cause or worsen dry eye symptoms.
04
Individuals working in environments with factors known to contribute to dry eye, such as prolonged computer use, exposure to air conditioning or heating, or exposure to smoke or chemicals.
05
People with a compromised immune system or specific systemic diseases, such as Sjögren's syndrome, rheumatoid arthritis, or thyroid disorders, which are commonly associated with dry eye.
06
Any individual who suspects they may have dry eye or is concerned about their eye comfort and wants to better understand their eye health.
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Dry eye assessment is a comprehensive evaluation to determine the presence and severity of dry eye syndrome.
Healthcare professionals, particularly ophthalmologists and optometrists, are required to conduct and file dry eye assessments.
Dry eye assessments are typically filled out by conducting tests such as tear film evaluation, symptom questionnaires, and ocular surface examinations.
The purpose of dry eye assessment is to diagnose, monitor, and treat dry eye syndrome in patients.
Information such as patient symptoms, tear film quality, ocular surface health, and treatment plans must be reported on dry eye assessments.
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