RESTASIS

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Do You Have Chronic Dry Eye?
Fill Out the Dry Eye Actionnaire.

Tell your eye doctor exactly how you feel about your current dry eye treatment. You may have Chronic Dry Eye (CDE). Answer ALL the ACTIONNAIRE questions below…and click the "FINISH ACTIONAIRRE" button at the bottom of the page. Make sure you take this with you when you visit your eye doctor.

Remember: only your eye doctor can determine what treatment is the best choice for managing your dry eye condition. So the more information you provide for your eye doctor, the more it will help your doctor select the treatment that works best for you.

1.Have you been using over-the-counter (OTC) eye drops for a long time?

Tell your eye doctor exactly how long:

2.Have you tried many types of OTC drops and artificial tears?

Tell your eye doctor exactly how many:

Tell your eye doctor their names: (Check all that apply)

  • Clear eyes®
  • Gen Teal®
  • OPTIVE™ Lubricant Eye Drops
  • REFRESH® Lubricant Eye Drops
  • Soothe® XP
  • Systane® Brand
  • Tears Naturale®
  • Thera®Tears
  • Visine Tears®
    • Other (please specify)

3.Are you using OTC drops often?

Tell your eye doctor exactly how often:

4.Do you feel like your use of OTC drops has increased over time?

Tell your eye doctor exactly how much:

5.Are your dry eyes affecting your daily activities?

If you answered "yes", please let your doctor know what activities are affected:

6.Are you concerned about your dry eyes?

If you answered "Yes", tell your doctor how your eyes feel:

7.Are you satisfied with your current dry eye treatment?

If you answered "No," make sure you tell your eye doctor.

8.Are you ready to discuss treatment options for your dry eye with your doctor?

If you answered “Yes,” don’t wait for your annual appointment. Contact your eye doctor TODAY and make an appointment to discuss treatment options for your dry eye.

 

FINISH QUESTIONNAIRE

If you don’t currently have an eye doctor, use our physician locator to find an eye doctor in your area.

REGISTRATION AND TRADEMARK INFORMATION
® and ™ marks owned by Allergan, Inc.
Clear eyes® and Murine® are registered trademarks of Prestige Brands, Inc.; GenTeal® is a registered trademark of Novartis Pharmaceuticals Corporation; Moisture Eyes™ is a trademark of Bausch & Lomb, Inc.; Systane® and Tears Naturale® are registered trademarks of Alcon, Inc.; Thera®Tears is a registered trademark of Advanced Vision Research, Inc.; Visine® is a registered trademark of Pfizer, Inc.

 

RESTASIS® Ophthalmic Emulsion helps increase your eyes’ natural ability to produce tears, which may be reduced by inflammation due to Chronic Dry Eye. RESTASIS® did not increase tear production in patients using topical steroid drops or tear duct plugs.

Important Safety Information:

RESTASIS® Ophthalmic Emulsion should not be used by patients with active eye infections and has not been studied in patients with a history of herpes viral infections of the eye. The most common side effect is a temporary burning sensation. Other side effects include eye redness, discharge, watery eyes, eye pain, foreign body sensation, itching, stinging, and blurred vision.

Please see product information for RESTASIS® Ophthalmic Emulsion.

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This information is intended for residents of the United States. ® and ™ marks owned by Allergan, Inc.