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LACRISERT® Symptom Survey

Are artificial tears (ATs) not providing the therapy you need to relieve your Dry Eye?

Take the following survey to learn if there is a more appropriate Dry Eye therapy for you. Once you have completed the survey, click "Submit" to print out your results. Bring your results to your Eye Care Professional and discuss your Dry Eye symptoms to find out if LACRISERT® is right for you.

 
1. Do you suffer from Dry Eye symptoms, including dryness, stinging,
burning, or grittiness?
2. Rate the average severity of your dry eye symptoms, on a scale of 1 to 5
(with 1 being the least severe and 5 being the most severe), over the past month:
smile facefrowning face
Least SevereMost Severe
Discomfort
Burning
Dryness
Grittiness
Light Sensitivity
Stinging
3. How often do you feel the need to use ATs in a single day?
4. Do you find yourself forgetting or being too busy to use ATs when your
eyes are in need of relief?
5. Which of the following common activities do you ever have difficulty doing
because of your Dry Eye?
6. Has Dry Eye impaired you from taking part in daily activities or does
it interfere with tasks you have to complete at your job?
7. If you wear contact lenses, do you find that repeated daily administration
of ATs or rewetting drops interferes with wearing them?
8. When administered, how long does/did the relief of 1 single AT drop last?
9. Do you feel the need to carry a bottle of ATs with you throughout the day?
10. Are you self-conscious when using ATs in public?
11. Do you find that you often have to reapply makeup after using ATs?
12. Are you looking for an AT that provides all-day relief, without repeated
administration?
If you answered Yes to the majority of questions, are using ATs 4 or more times a day, and are bothered by your Dry Eye symptoms, LACRISERT may be right for you.

Indications and Usage

LACRISERT® is indicated in patients with moderate to severe Dry Eye syndromes, including keratoconjunctivitis sicca. LACRISERT® is indicated especially in patients who remain symptomatic after an adequate trial of therapy with artificial tear solutions. LACRISERT® is also indicated for patients with exposure keratitis, decreased corneal sensitivity, and recurrent corneal erosions.

Important Safety Information

LACRISERT® is contraindicated in patients who are hypersensitive to hydroxypropyl cellulose. Instructions for inserting and removing LACRISERT® should be carefully followed. If improperly placed, LACRISERT® may result in corneal abrasion. Because LACRISERT® may cause transient blurred vision, patients should be instructed to exercise caution when driving or operating machinery. Patients should be cautioned against rubbing the eye(s) containing LACRISERT®.

The following adverse reactions have been reported, but were in most instances, mild and temporary: transient blurring of vision, ocular discomfort or irritation, matting or stickiness of eyelashes, photophobia, hypersensitivity, eyelid edema, and hyperemia.

Talk to your doctor if you have side effects that bother you or that do not go away. You are encouraged to report side effects of prescription drugs to the FDA. Visit www.FDA.gov/medwatch or call 1-800-FDA-1088.

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©2012 Valeant Ophthalmics, a division of Valeant Pharmaceuticals North America LLC          Bridgewater, NJ 08807