Dry Eye Questionnaire
What a dry eye questionnaire asks, with sample questions on symptoms, triggers, and treatments tried.
A dry eye questionnaire records eye symptoms, triggers, treatments tried, contact lens wear, medicines, and health history before a dry eye visit. The questions on this page are built from two eye practices' dry eye questionnaires and a SUNY Downstate eye history form.
Dry eye questionnaire, handled by the AI Doctor avatar
AI Doctor, a real-time AI healthcare assistant avatar, asks the questions on a dry eye questionnaire in the patient's own language, strictly following the practice's instructions.
- Intake before the visit. Patients answer online before they arrive, or at a kiosk when they check in.
- Answers ready for the clinician. Clinicians see what the patient said before the visit starts.
- Less workload at the front desk. Staff spend less time handing out forms and entering answers by hand.
- Key details at a glance. The care team sees what matters up front and decides who needs attention first.
The form becomes a natural conversation: patients answer by talking, in their own words. AI Doctor is an information and patient-assistance interface. It collects answers for the care team to review. It doesn't diagnose, triage, or give treatment advice.
Sample dry eye questionnaire questions
Typical questions, written out so you can see the level of detail. Every practice words its own form differently.
- Which eye symptoms bother you most?Eye symptoms
- Does your vision change during the day?Eye symptoms
- Do wind or dry air make it worse?Triggers
- Are your eyes worse in air-conditioned or heated rooms?Triggers
- Do you use artificial tears, and how often?Treatments
- Which dry eye treatments have you tried?Treatments
- Do you wear contact lenses?Contact lenses
- How many hours can you wear them comfortably?Contact lenses
- Which prescription and over-the-counter medicines do you take?Medications
- Do you use any other eye drops?Medications
- Have you been diagnosed with Sjogren's syndrome?Health history
- Have you had cataract, glaucoma, or refractive surgery?Health history
These are examples to read, not a form to fill in.
Dry eye questionnaire: FAQ
What does a dry eye questionnaire ask?
The sample questions on this page are based on two eye practices' dry eye questionnaires and SUNY Downstate's ophthalmology medical history questionnaire. This page groups them into six areas: eye symptoms, triggers, treatments, contact lenses, medications, and health history.
Who fills in a dry eye questionnaire, and when?
The patient, before a dry eye visit. One of the practices' forms also has a line for the technician's name.
Does it ask about conditions outside the eyes?
Yes. The SUNY Downstate form's review of systems covers conditions such as arthritis, diabetes, lupus, and Sjogren's syndrome.
Does it ask about the patient's surroundings?
It can. One practice's form asks whether wind, low humidity, or air-conditioned or heated rooms go along with the symptoms.
Is there a dry eye questionnaire template?
Both practices publish their dry eye forms as PDFs. The sample questions on this page show a typical set.
What happens after the answers are in?
The doctor reviews them along with the eye exam, and one practice's form ends with a line where the attending clinician notes the review. AI Doctor only collects the answers.
Does AI Doctor give medical advice?
No. It collects information for the care team. It doesn't diagnose, triage, or recommend treatment.
Can patient answers stay on our own servers?
Yes. RAVATAR offers on-prem deployment: the platform can run inside your own perimeter, so patient answers stay there. RAVATAR complies with GDPR and the EU AI Act.
Set up your AI Doctor in Genesis AI Avatar Studio
Genesis AI Avatar Studio is where you set up, test, and publish AI avatars for your website, mobile app, or Holobox. No coding or technical skills needed.
- 01Choose the AI Doctor avatar.
- 02Add your practice's FAQs and visit information.
- 03Talk to it, then publish it.
