(B) Questionnaire

Patient id no:

Sl no Question Response

1. Gender Male
Female

2. Area of living Urban

 Rural

3. Educational status  Unable to read and write

 Read and write only
 Primary school
 Secondary school
 Collage/ University

4. Occupation Indoor-

Housewife
Teacher
Student
 Garment worker
 Other(specify)-

Outdoor-

 Construction workers
 Day laborer
Farmer
Security guards
 Others(specify)-

5. Presenting complaints:
Yes
● Fleshy mass
 No

Yes
● Foreign body sensation
 No

Yes
● Blurring of vision
  No

● Others(specify)
6. Eye involve Right

 Light

Both

7. Have you exposed to dust Yes

 No

8. Have you exposed to wind Yes

 No

9. For how many times do you exposed to hr/day

sunlight per day?

For how many periods do you spend your hr/day

10. time on outdoor activities?

11. Do you have any family history of Yes

pterygium (among the first-degree No
relatives)?

12. Dry eye questionnaire-

a) Do your eyes ever feel dry?  Yes
b) Do you feel gritty sensation in your  No
eyes?

13. Past history: 

Yes
Any other ocular disease-  No

If yes, name & duration of the disease-

Yes
Any ocular therapy or surgery- No

If yes, name & duration -

Any ocular injury- Yes

 No

If yes, name & duration of the disease-

14. Drug history:


Use of any systemic or topical drug- Yes
No


History of drug allergy- Yes
No

15. 
Personal history-

Smoking Yes
No


Betal nut
Yes
No

16. Monthly income

