RESTASIS

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Do You Have Chronic Dry Eye?

You can help your eye doctor determine whether you have Chronic Dry Eye by describing your condition in detail and sharing all your questions. It may help to fill it out now, print it and bring it with you on your next visit.

When did you notice your eyes were producing fewer tears?

How would you describe the way your eyes feel?

How often do you use artificial tears?

Has your use of artificial tears increased over time?

FINISH QUESTIONNAIRE

Review this questionnaire with your eye doctor to determine if a prescription for RESTASIS® is right for you.

 

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Allergan, Inc.

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This information is intended for residents of the United States. ® and ™ marks owned by Allergan, 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 steroids 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 prescribing information for RESTASIS® Ophthalmic Emulsion.