pn001 | Have you noticed any new eye pain in the last six months (for example, burning, throbbing, itching, etc)? | any new eye pain in the last six months |
pn002 | Do you wear contact lenses? | wear contact lenses |
pn003 | Over the last month, have you had trauma to the eye or eyelid (for example being struck in the eye while playing a sport)? | had trauma to the eye or eyelid |
pn004 | Has something gotten into your eye? | something gotten into eye |
pn005 | Has your vision gotten worse since you started experiencing new eye pain? | vision gotten worse since started experiencing new eye pain |
pn006 | Does your eye pain improve after using artificial tears? | eye pain improve after using artificial tears |
pn007 | When did your eye pain start?
| when did eye pain start |
pn008 | How often does your eye pain occur?
| how often eye pain occur |
pn009 | Over the last month, is your new eye pain getting better, worse, or about the same?
| new eye pain getting better, worse, or about the same |
pn010 | How would you describe your new eye pain? (please check all that apply) | describe new eye pain |
pn010_order | | order answer options describe new eye pain |
pn011 | Along with your new eye pain, do you also have cold or flu symptoms (e.g., sore throat, runny nose)? | with new eye pain, also have cold or flu symptoms |
pn012 | Do you have seasonal allergies? | have seasonal allergies |
pn013 | Are you taking blood thinners and have developed a new red patch on the white part of your eye? | taking blood thinners and have developed a new red patch on the white part of eye |
pn014 | Does your eye pain occur when concentrating on something at arm's length reading distance or closer? | eye pain occur when concentrating on something at arms length reading distance or closer |
pn015 | Does the eye pain occur along with blurred vision when you use any of the following medications?
- Diphenhydramine [Benadryl], promethazine [Phenergan], or other antihistamines
- Tropicamide, phenylephrine, or pilocarpine eye drops
- Ipratropium [Atrovent] or other asthma inhaler
- Botulinum Toxin [Botox] injection around the eye
- Imipramine [Tofranil], amitriptyline [Elavil], or other tricyclic antidepressants (TCAs)
- Fluoxetine [Prozac] or other selective serotonin reuptake inhibitors (SSRIs)
- Fluphenazine [Modecate] or other antipsychotics
- Oxymetazoline [Afrin] or other nasal decongestant sprays
- Topiramate [Topamax], acetazolamide [Diamox], or other sulfa-based drugs
- Heparin
- Ephedrine, epinephrine, or amphetamines (ie MDMA, cocaine)
| eye pain occur along with blurred vision when use any medications |
pn016 | Along with the pain around your eye socket, do you have sinus symptoms like congestion and stuffy nose or chronic sinus disease? | have sinus symptoms like congestion and stuffy nose or chronic sinus disease |
pn017 | In the last six months, have you noticed feeling as if you are constantly tearing? | noticed feeling as if you are constantly tearing |