Appointment Preparation

A worksheet to help aid communication during eye care appointments about dry eye

1. Symptoms

I am experiencing the following symptoms:

(list any symptoms of pain or discomfort, vision concerns, eye redness, etc; share briefly any patterns you’ve noticed e.g. times of day, and environments, activities where symptoms recur)

These symptoms affect my life in the following ways/degree:

My OSDI (or SPEED) score is:

For me, successful treatment would look like this:

(be specific; work on identifying specific functional goals and why you can’t achieve them right now; what is your #1 priority?)

2. Diagnosis

My doctor has diagnosed the following medical condition(s):

Questions I may wish to ask if the doctor does not mention them: Can you tell me what kind of dry eye I have? Am I producing enough tears? Are the oil glands in my eyelids healthy? Can you give me any more details about my diagnosis?

Note: Feel free to ask your doctor questions about the tests they use, but we do not recommend expecting your doctor to use specific diagnostic tests. Sophisticated equipment is not necessary for most ocular surface disease diagnoses. Choose your doctor well and trust their diagnostic process.

My doctor feels medical treatment is/is not indicated because:

3. Treatment plan and expectations

Recommended treatment plan

___ Home care:

___Prescription medication: Indicated for:

___Punctal occlusion:

___Procedure / intervention(s):

___Specialty lenses:

___Other:

Expectations

  • Best case, what could this treatment do for me?

  • How/when will I know it’s helping?

  • What should I expect in the short term, especially for the first few days/weeks? Will it make me worse in the short term?

  • Any risks or common side effects I should be aware of?

  • Is this treatment FDA approved?

  • (for medications) If I feel I need to discontinue, should I call first?

  • I should return in apprx. _____ weeks fo assess progress

4. Self-care steps to improve my symptoms

___ OTC lubricant eye drops (gels, ointments)

___ Eyelid care: hygiene? warm compresses? Any specific instructions or cautions?

___ Nutrition and supplements

___ Cold compresses (for pain)

___ Protection: moisture-retaining glasses/sunglasses? night mask/shield or adhesives?

___ Screen time strategies (screen positioning, blink reminders, lubricant drops preventively)

___ Blink exercises

___ Environmental modifications e.g. humidifier, redirecting vents

___ Other lifestyle modifications e.g. reduce screen time, reduce cosmetics, other