Questionnaires to assess patient’s subjective perception of dry eye syndrome symptoms – an invaluable diagnostic aid

In diagnosing dry eye syndrome, questionnaires are invaluable for estimating the extent of the condition and the number of symptoms in patients who experience this very widespread ocular surface disorder.

There are two forms of PMS:

• caused by excessive evaporation of the tear film (Evaporative Dry Eye – EDE) – 80% of cases,
• occurring due to a deficiency of the aqueous component of the tear film (Aqueous-Deficient Dry Eye – ADDED) – 20% of cases.

To meet the needs of patients, doctors have prepared and continue to refine questionnaires to assess their subjective experience of symptoms of dry eye syndrome.

The more objective and reproducible data can be collected from patients, the easier it is to implement treatment methods adequate to their needs, and in the case of non-specific, individual ailments – to seek new therapeutic solutions.

Ophthalmologists have at their disposal, among other things:

• NEI-VFQ 25 questionnaire consisting of 25 questions. It gives a score on a scale of 0 to 100 points (0 is the worst score and 100 is the best score and means the patient has no visual problems). This questionnaire is based on the original 51-item version of the NEI-VFQ, and is easier to complete, but equally multidimensional, reliable and accurate. The NEI-VFQ 25 has several subscales that assess, among other things, general health, general vision, difficulty with near vision, difficulty with distance vision, limitations in social functioning due to vision, and others.
• OSDI questionnaire consisting of 12 questions (it is referred to as the gold standard in diagnostic testing). It helps to make a quick assessment of the symptoms of eye irritation in dry eye syndrome and evaluate their impact on vision-related functioning. The questionnaire has 3 subscales: ocular symptoms, vision-related functions and environmental factors. Patients rate their responses on a scale from 0 to 4 (0 = never “and 4 = all the time). The final score is a summary of points ranging from 0 to 100: 0 – 12 is normal, 13 – 22 is mild dry eye syndrome, 23 – 32 is moderate dry eye syndrome, and above 33 is severe dry eye syndrome. The OSDI assesses a small number of dry eye syndrome symptoms, including sensitivity to light, a sensation of sand under the eyelids and pain. The questionnaire does not assess other symptoms, such as tearing and foreign body sensation.
• SPEED questionnaire. It assesses the following symptoms: dryness, feeling of sand under the eyelids, itching, irritation, burning, tearing, soreness and eye fatigue. This questionnaire gives a score from 0 to 28, analyzing the result of 8 items assessing the frequency and severity of symptoms.

Let’s return to the OSDI questionnaire, which is referred to as the gold standard in ophthalmic research. Such a questionnaire is completed by patients at various intervals, such as before, during and after procedures.

It takes into account different categories of daily activities. By monitoring the patient’s subjective feelings, the doctor is able to individualize therapeutic methods.

Patients with dry eye spend years being told that “everything is normal”, because a standard examination does not measure their complaints. The OSDI questionnaire plus meibomian gland imaging put an end to that wandering – the result is there in black and white and can be compared after every stage of therapy.

dr med. Victor Derhartunian, FEBO, FWCRS

Next step: book your dry eye diagnostic work-up (200 zł, Warsaw or Kraków) – therapy is carried out by our experienced, highly qualified optometrists.

Content medically reviewed by Dr. med. Victor Derhartunian, FEBO, FWCRS · Last updated: 17.08.2026