Dry eye self-test: what the OSDI questionnaire measures

A "dry eye self-test" almost always means the Ocular Surface Disease Index, usually shortened to OSDI. It is a short symptom questionnaire, scored from 0 to 100, where a higher number means a heavier symptom burden. It was formally validated in 2000 and it remains one of the instruments dry eye clinics and clinical trials reach for first.

What it will not do is diagnose you. A questionnaire measures how your eyes feel, and how your eyes feel is only loosely related to what an optometrist sees at the slit lamp. A high score tells you something is worth investigating. A low score does not rule dry eye out.

We do not host an interactive OSDI quiz on this site. The questionnaire is a copyrighted instrument and reproducing its wording is not ours to do. What follows is what it covers, what the score bands mean, and a short set of questions in our own words that you can work through before an appointment.

What the Ocular Surface Disease Index measures

Schiffman and colleagues published the validation study in 2000. One hundred and nine patients with dry eye and thirty normal controls completed the OSDI alongside several other questionnaires, and had an ophthalmic examination that included Schirmer tests, tear breakup time, and fluorescein and lissamine green staining.

Factor analysis pulled three subscales out of the answers. In the authors' terms these are:

• Ocular symptoms — how the eyes themselves feel.
• Vision-related function — whether the symptoms get in the way of ordinary visual tasks.
• Environmental triggers — whether particular surroundings make things worse.

Reliability was good to excellent for the overall instrument and for each subscale, and test–retest reliability was good to excellent. The OSDI discriminated between normal, mild to moderate and severe dry eye, whether severity was defined by the physician's assessment or by a composite disease severity score, and it correlated significantly with the McMonnies Dry Eye Questionnaire, with a vision function questionnaire, with the patient's own perception of symptoms and with how much artificial tear they were using. The authors concluded it is a valid and reliable instrument for measuring the severity of dry eye disease, with the properties needed to serve as an end point in clinical trials.

Read that conclusion carefully, because it is the honest scope of the tool. The OSDI measures the severity of a symptom experience. It was not designed to tell you what is causing that experience.

What the score bands mean

The Meibomian Gland Dysfunction Workshop's diagnosis report sets out the ratings across the 0 to 100 scale as follows, and notes that a change of seven units is regarded as clinically significant.

Two cautions about bands. A single score is a snapshot of a variable condition, and most people's eyes are worse on some days than others, so one number taken on a bad afternoon overstates the average. And the bands describe symptom burden, not disease mechanism. Two people with a score of 30 can need completely different treatment.

Why clinicians start with a questionnaire

The TFOS DEWS II diagnostic methodology report puts symptom screening at the front of the sequence deliberately: a validated questionnaire is what confirms that a patient might have dry eye disease and triggers the objective tests that follow, which we walk through in dry eye tests explained.

Only after that does the report use meibomian gland assessment, lipid thickness and dynamics, and tear volume to sub-classify the disease as predominantly evaporative or predominantly aqueous deficient, which is the part that actually informs treatment.

So the questionnaire is a gate, not a verdict. It decides whether the rest of the work-up is worth doing.

The gate is imperfect in one direction in particular. The same MGD workshop report notes that meibomian gland dysfunction can be an asymptomatic, subclinical condition, detectable only by gland expression or meibography. People can have glands that are already dropping out and score in the normal band. If that sounds like it could be you, our explainer on what meibomian gland dysfunction is covers the signs that do not announce themselves.

Questions to ask yourself, in our words

The list below is ours. It is not the OSDI, it produces no score, and it is not a diagnosis. It exists so that you turn up to an appointment with better information than "my eyes feel dry sometimes". Write the answers down.

1. When in the day are your eyes at their worst? On waking, or by late evening? The answer often points in different directions.
2. Which activities make it worse? Close work of any kind, long stretches at a screen, driving after dark, a heat pump or fan blowing across the room, a windy day outdoors.
3. Does your vision blur and then clear when you blink? If so, how many seconds after a blink does it go?
4. Do your eyes water at the wrong moments — in wind, in the cold, or for no obvious reason? Watering is a common dry eye complaint rather than a contradiction of it.
5. How do your lids look and feel on waking? Crusted, stuck, red, swollen, or itchy along the lash line.
6. Is itch the dominant symptom? Itch that leads everything else points more towards allergy than dryness.
7. Do lubricating drops help, and for how long? Minutes, or hours? A very short-lived benefit is itself informative.
8. What changed, and when? New medication, contact lenses, a new job or office, pregnancy or menopause, a skin condition, a course of isotretinoin, recent eye surgery.
9. How much does this actually bother you? Answer on your own terms, from "barely notice it" to "it shapes my day".

Bring that page with you. It tells an optometrist more than a number does, and it costs you nothing.

What a self-test cannot tell you

The thing a symptom score cannot do is tell you which kind of dry eye you have, and that is the question treatment turns on. The TFOS DEWS II definition and classification report describes aqueous deficient and evaporative dry eye as a continuum, with elements of each considered in diagnosis and management, rather than two separate diseases you can sort yourself into from a questionnaire. If you want the distinction properly, start with evaporative versus aqueous-deficient dry eye and then which type you are likely to have.

A score also cannot see your lid margins, cannot measure your tear film, and cannot exclude the conditions that mimic dry eye. If you have an active eye infection, have had eye surgery recently, have glaucoma, or notice any change in your vision, see your optometrist or ophthalmologist rather than working from a self-test.

If your answers lean towards the evaporative side — worse by evening, worse on screens, lids that feel heavy or crusted — eyelid warming is one of the first-line measures guideline groups recommend, and the Meibocare E-Heated Eye Mask is designed to bring the eyelids to about 42 °C on the recommended setting and timer. It is worth being plain about the limits. A heated mask is aimed at the meibomian glands and the evaporative side of dry eye. If reduced tear production is your problem, warming the lids is not the answer, and no questionnaire score on its own can tell you which of the two you have.

If you have an active eye infection, have had eye surgery recently, have glaucoma, or notice any change in your vision, speak to your optometrist or ophthalmologist before starting heat therapy or continuing with it.

Frequently asked questions

What is the OSDI dry eye questionnaire?

The Ocular Surface Disease Index is a short symptom questionnaire scored from 0 to 100. Its 2000 validation study found three subscales by factor analysis: ocular symptoms, vision-related function, and environmental triggers. Reliability and test–retest reliability were good to excellent, and the score discriminated between normal, mild to moderate and severe dry eye. It measures symptom severity, not cause.

What is a normal OSDI score?

The Meibomian Gland Dysfunction Workshop's diagnosis report gives the ratings as normal from 0 to 12, mild from 13 to 22, moderate from 23 to 32, and severe from 33 to 100, with a seven-unit change treated as clinically significant. Treat the bands as a guide. A single score taken on a bad day overstates your usual symptom level.

Can an online dry eye test diagnose dry eye?

No. In the TFOS DEWS II diagnostic sequence a symptom questionnaire confirms that a patient might have dry eye disease and triggers further tests, rather than settling the matter. Diagnosis needs breakup time, tear osmolarity and ocular surface staining, plus a lid examination to sub-classify the disease. A questionnaire cannot tell evaporative from aqueous-deficient dry eye.

Can you have dry eye with a low symptom score?

Yes. Meibomian gland dysfunction can be asymptomatic and subclinical, detectable only by gland expression or meibography, so glands can be obstructed or lost while a symptom questionnaire reads as normal. This is why an examination matters if your lids look inflamed, your vision blurs between blinks, or you have risk factors, even with a comfortable score.

Educational information only, not medical advice. References: Schiffman RM, et al. Arch Ophthalmol. 2000;118:615–621; Wolffsohn JS, et al. Ocul Surf. 2017;15:539–574; Tomlinson A, et al. Invest Ophthalmol Vis Sci. 2011;52:2006–2049; Craig JP, et al. Ocul Surf. 2017;15:276–283; Jones L, et al. Ocul Surf. 2017;15:575–628.