OSDI (Ocular Surface Disease Index)

The Ocular Surface Disease Index (OSDI) is a validated 12-question questionnaire that assesses the severity of dry eye disease symptoms and their impact on your daily life. It evaluates three areas: ocular symptoms, vision-related function, and environmental triggers. The OSDI is one of the most widely used tools in clinical practice and research for measuring dry eye severity.

Why It's Done

The OSDI is used to:

• Measure dry eye symptom severity
• Assess how dry eye affects daily activities
• Identify environmental triggers
• Track treatment response over time
• Classify disease as mild, moderate, or severe
• Support dry eye research and clinical trials

What to Expect

Before the Questionnaire

• No preparation needed
• Think about your eye symptoms over the past week

During the Questionnaire

The OSDI covers three areas:

Ocular Symptoms (Questions 1-5):

• Light sensitivity
• Gritty or sandy feeling
• Painful or sore eyes
• Blurred vision
• Poor vision

Vision-Related Function (Questions 6-9):

• Difficulty reading
• Difficulty driving at night
• Difficulty using a computer or phone
• Difficulty watching TV

Environmental Triggers (Questions 10-12):

• Discomfort in windy conditions
• Discomfort in low-humidity environments
• Discomfort in air-conditioned areas

Each question is scored 0-4 (none of the time to all of the time).

After the Questionnaire

• Your score is calculated and shared with you
• Results help guide treatment decisions
• Follow-up scores track your progress

Understanding Results

OSDI Score Ranges

Score	Severity
0-12	Normal
13-22	Mild dry eye
23-32	Moderate dry eye
33-100	Severe dry eye

What the Scores Mean

• Normal (0-12): Minimal symptoms; dry eye unlikely to be significantly affecting quality of life
• Mild (13-22): Some symptoms present; may benefit from basic dry eye treatments
• Moderate (23-32): Symptoms affecting daily activities; targeted treatment recommended
• Severe (33-100): Significant impact on quality of life; comprehensive treatment plan needed

OSDI vs. Other Questionnaires

Questionnaire	Questions	Best For
OSDI	12	Comprehensive severity assessment
DEQ-5	5	Quick screening
SPEED	8	Symptom frequency and severity

When Is Each Used?

• OSDI: Gold standard for clinical trials; comprehensive assessment including functional impact
• DEQ-5: Quick screening when time is limited; identifies who needs further evaluation

Part of a Complete Dry Eye Assessment

The OSDI is typically used alongside objective tests:

• Tear break-up time (TBUT)—tear stability
• Schirmer test—tear production
• Meibography—gland structure
• Tear osmolarity—tear concentration
• MMP-9 testing—inflammation

Frequently Asked Questions

Why do I need a questionnaire if the doctor can examine my eyes?

Dry eye symptoms don't always correlate with clinical signs. Some patients have significant symptoms with mild signs, and vice versa. The OSDI captures your experience—how dry eye actually affects your life—which objective tests alone may miss.

Can my OSDI score change?

Yes, and that's one of its main uses. As treatment takes effect, your OSDI score should decrease. A meaningful improvement is generally considered a decrease of 7-10 points or more.

I scored high but my eyes look fine—why?

Some forms of dry eye cause significant symptoms before visible damage appears. Additionally, neuropathic pain and central sensitization can cause dry eye symptoms even with a relatively normal-appearing ocular surface.

Is the OSDI the same every time?

The questions are always the same, but your answers may vary based on recent symptoms, season, environment, and treatment. This variability is normal and is part of what makes repeat testing valuable.

How often should the OSDI be administered?

Typically at initial evaluation and at follow-up visits (often every 1-3 months when monitoring treatment). Your doctor will determine the appropriate schedule.