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Patient Name: RIGHT EYE Date: LEFT EYE DRY EYE QUESTIONNAIRE PART 1: SPEED OF 2 PAGE 1 Please answer the following questions by checking the box that best represents your answer. Select only one answer.

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Types: Schirmer I (without anesthetic): measures baseline and reflex tear secretion. function of main lacrimal gland, whose secretory activity is stimulated by the irritating nature of filter paper. Schirmer II (with anesthetic): measures baseline secretion. ... Schirmer III (without anesthetic): with nasal irritation.

Both questionnaires target the frequency of dry eye symptoms, although the listed symptoms are not identical, e.g. the SPEED questionnaire refers to eye soreness, grittiness, scratchiness, pain, irritation, burning, watering and fatigue where as the OSDI refers to light sensitivity, eye pain, grittiness, or soreness ...

If your score is: 0-4 you are experiencing MILD dry eye symptoms. 5-7 you are experiencing MODERATE dry eye symptoms. 8+ you are experiencing SEVERE dry eye symptoms. The SPEED Questionnaire is one tool we use to help assess your dry eye symptoms.

The Schirmer test is one of the most important tests used to diagnose dry eye disease and clinical end points. A Schirmer test score >10 mm in 5 minutes is widely accepted as the normal value, whereas a score <5 mm is indicative of tear deficiency.

The Schirmer test is used in ophthalmic examination to measure tear production for the diagnosis of conditions such as keratoconjunctivitis sicca and dry eye, which can manifest in a number of symptoms such as foreign body or gritty sensations, burning/stinging, tearing, photophobia, and/or intermittent sharp pains in ...

Standard Patient Evaluation of Eye Dryness Questionnaire (SPEED) The SPEED questionnaire was designed by Korb and Blackie in order to quickly track the progression of dry eye symptoms over time. This questionnaire gives a score from 0 to 28 that is the result of 8 items that assess frequency and severity of symptoms.

The Schirmer I test is performed without anesthesia and, thus, measures basic and reflex tearing. The Schirmer II test also lacks anesthesia but is done following nasal stimulation; it measures reflex tearing only and has has been shown to be reduced more in Sjögren's syndrome compared to non-Sjögren's dry eye.

Schirmer's test is used to determine whether the eye produces enough tears to keep it moist. The test is performed by placing filter paper inside the lower lid of the eye. After 5 minutes, the paper is removed and tested for its moisture content.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232