Eyelid Surgery Post-Op QPROM

Thank you for having your eyelid surgery at Kinvara Private Hospital. Please complete this short questionnaire (known as a Quality Patient-Reported Outcome Measure – QPROM).

The questionnaire should only be completed by patients that have had eyelid surgery and will only take a few minutes.

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Date of birth
Which eyelids did you have surgery on?

Answer the questions with how dissatisfied or satisfied have you been with your eyes, in the past week;

1. How nice your eyes look?
2. The shape of your eyes
3. How open your eyes look
4. How alert (not tired) your eyes look?
5. How bright eyed you look?
6. How attractive your eyes look?
7. How youthful your eyes look?

Following surgery do you experience any of the following:

8. Difficulty closing your eyes
9. Dry eyes
10. Excessive tearing
11. Eye irritation (redness, itching)?
12. Your eyes look hollowed out?
13. How your eyelid scars look (obvious, noticeable, uneven)?