Ocular Surface Disease Questionnaire Answer the following 12 questions, and check the number in the box that best represents each answer. Then, fill in boxes A, B, C, D, and E according to the instructions beside each. Name:*Email* PhoneHAVE YOU EXPERIENCED ANY OF THE FOLLOWING DURING THE LAST WEEK:1. Eyes that are sensitive to light?All of the timeMost of the timeHalf of the timeSome of the timeNone of the time2. Eyes that feel gritty?All of the timeMost of the timeHalf of the timeSome of the timeNone of the time3. Painful or sore eyes?All of the timeMost of the timeHalf of the timeSome of the timeNone of the time4. Blurred vision?All of the timeMost of the timeHalf of the timeSome of the timeNone of the time5. Poor vision?All of the timeMost of the timeHalf of the timeSome of the timeNone of the timeSubtotal score for answers 1 to 5HAVE PROBLEMS WITH YOUR EYES LIMITED YOU IN PERFORMING ANY OF THE FOLLOWING DURING THE LAST WEEK:6. Reading?All of the timeMost of the timeHalf of the timeSome of the timeNone of the time7. Driving at night?All of the timeMost of the timeHalf of the timeSome of the timeNone of the time8. Working with a computer or bank machine (ATM)?All of the timeMost of the timeHalf of the timeSome of the timeNone of the time9. Watching TV?All of the timeMost of the timeHalf of the timeSome of the timeNone of the timeSubtotal score for answers 6 to 9HAVE YOUR EYES FELT UNCOMFORTABLE IN ANY OF THE FOLLOWING SITUATIONS DURING THE LAST WEEK:10. Windy conditions?All of the timeMost of the timeHalf of the timeSome of the timeNone of the time11. Places or areas with low humidity (very dry)?All of the timeMost of the timeHalf of the timeSome of the timeNone of the time12. Areas that are air conditioned?All of the timeMost of the timeHalf of the timeSome of the timeNone of the timeSubtotal score for answers 10 to 12