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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.
  • HAVE YOU EXPERIENCED ANY OF THE FOLLOWING DURING THE LAST WEEK:
  • HAVE PROBLEMS WITH YOUR EYES LIMITED YOU IN PERFORMING ANY OF THE FOLLOWING DURING THE LAST WEEK:
  • HAVE YOUR EYES FELT UNCOMFORTABLE IN ANY OF THE FOLLOWING SITUATIONS DURING THE LAST WEEK:
x

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