Introduction
Dry Eye Questionnaire-5 (DEQ-5) is a highly prevalent ocular surface condition that significantly affects visual comfort, functional performance, and overall quality of life. Moreover, its prevalence increases with age and is influenced by environmental exposure, systemic disease, and medication use. Consequently, accurate and efficient symptom assessment has become a central component of both clinical ophthalmology and vision research.
This article provides a comprehensive expert-level overview of the Dry Eye Questionnaire-5 (DEQ-5), a concise self-administered screening tool developed to assess the frequency and severity of dry eye symptoms. The article outlines its structure, scoring method, psychometric properties, clinical applications, and practical considerations for researchers and clinicians.
Key Features of the Dry Eye Questionnaire-5 (DEQ-5)
Purpose and Use
The primary purpose of the DEQ-5 is to screen for and quantify dry eye symptom burden, with a specific focus on dryness, ocular discomfort, irritation, and reflex tearing. Therefore, it enables early identification of symptomatic individuals and supports clinical decision-making in busy practice environments.
Target Population
The DEQ-5 is validated for adults aged 18 years and older, including:
- Young adults (18–24 years)
- Middle-aged adults (25–44 years)
- Older adults (45–64 years)
- Seniors (65+ years)
It is commonly used in ophthalmology and optometry clinics, as well as in population-based screening and research studies.
Structure
The questionnaire consists of 5 items designed to assess the core symptoms of dry eye disease. These items are organized around the following symptom dimensions:
● Dryness
● Discomfort and irritation
● Watery eyes (reflex tearing)
Furthermore, the questionnaire uses Likert-type response scales, with frequency items scored on a 0–4 scale and intensity items scored on a 0–5 scale, enabling rapid completion and straightforward interpretation in both clinical and research settings.
Scoring Method
The questionnaire uses a mixed frequency-intensity scale:
- Items 1, 2, and 5 assess symptom frequency and are scored from 0 (Never) to 4 (All the time)
- Items 3 and 4 assess symptom intensity and are scored from 0 to 5 (Very severe)
All responses are summed to yield a total score ranging from 0 to 22.
- A score of ≥ 6 indicates a positive screen for clinically significant dry eye disease
- A score of > 12 raises suspicion for Sjögren’s syndrome
Administration Format
The DEQ-5 is self-administered and requires less than 5 minutes to complete. It can be administered via:
- Paper-based forms
- Digital or online platforms
- In-person interviews
- Phone or video consultations
No training is required for administration or interpretation.
Applications of the Dry Eye Questionnaire-5 (DEQ-5)
The DEQ-5 supports multiple clinical and research applications, including:
- Screening for Dry Eye Disease
- Diagnostic support alongside clinical tests
- Monitoring symptom severity over time
Research outcome measurement in epidemiological and interventional studies
Languages and Availability
The DEQ-5 is available in several validated languages, including:
- English
- Arabic
- Turkish and Other languages
The questionnaire is free to use and distributed under an open-access Creative Commons (CC BY) license, and therefore does not require special permission for use in academic research or clinical practice, including studies published in PubMed-indexed journals.
Reliability and Validity
The DEQ-5 is considered highly reliable and valid. Psychometric evaluation demonstrates a Cronbach’s alpha > 0.70, indicating good internal consistency.
Limitations and Considerations
However, despite its strengths, the DEQ-5 has a few limitations:
- Self-report measure: Responses may be influenced by subjective interpretation
- Cultural bias: Symptom perception may vary across populations
- Language barriers: Not all languages have extensive validation
- Narrow focus: Psychological and systemic contributors are not assessed
- Age restrictions: Not validated for pediatric populations
Other Versions and Related Questionnaires
The DEQ-5 is a shortened form of the original Dry Eye Questionnaire (DEQ), which contains more items and provides a more detailed assessment of dry eye symptoms, making it suitable for in-depth research applications.
Complementary Questionnaires:
● Ocular Surface Disease Index (OSDI): Assesses symptom severity and the impact of dry eye on daily activities.
● Standard Patient Evaluation of Eye Dryness (SPEED): Evaluates the frequency and progression of dry eye symptoms over time.
● McMonnies Dry Eye Questionnaire: Screens for dry eye disease and associated risk factors.
Additional Resources
Frequently Asked Questions (FAQ)
- Who can use the DEQ-5?
Clinicians, researchers, and eye-care professionals use the DEQ-5 for adults aged 18 and older presenting with dry eye symptoms. - How long does it take to complete the DEQ-5?
Patients typically complete the DEQ-5 in less than five minutes, making it highly feasible for routine practice. - How is the DEQ-5 administered?
Healthcare teams administer the DEQ-5 via paper forms, digital platforms, or interview formats.
4.Is there any cost to using the DEQ-5?
The DEQ-5 is free to use and distributed under open-access and Creative Commons licensing.
A Word from ResRef about the Dry Eye Questionnaire-5 (DEQ-5)
The DEQ-5 exemplifies efficient psychometric design by distilling the complex symptomatology of Dry Eye Disease into five focused questions. Consequently, it provides clinicians and researchers with a rapid, reliable, and clinically actionable assessment tool for ocular surface disease.
References
- Chalmers, R. L., Begley, C. G., & Caffery, B. (2010). Validation of the 5-Item Dry Eye Questionnaire (DEQ-5): Discrimination across self-assessed severity and aqueous tear-deficient dry eye diagnoses. Contact Lens and Anterior Eye, 33(2), 55–60. link
- Bouazza, S., et al. (2024). Cross-cultural validation of the Arabic version of the Dry Eye Questionnaire-5 (DEQ-5). Contact Lens and Anterior Eye.link
- Yıldırım, Y., et al. (2024). Turkish version of the Dry Eye Questionnaire-5: Translation, validity, and reliability. Contact Lens and Anterior Eye.link
4.Sánchez-González, J. M., et al. (2019). Transcultural validation of the 5-Item Dry Eye Questionnaire for the Mexican population. International Ophthalmology, 39(11), 2549–2557..link
