OBJECTIVE: To develop an instrument to assess the impact of ocular allergy symptoms. General health and allergy questionnaires do not adequately address the specific concerns of patients who suffer from chronic and/or seasonal ocular allergies and see ophthalmologists. METHODS: We modified an instrument, the Dry Eye Disease Impact Questionnaire (DEDIQ), to create the pretest version of the EAPIQ. Following pretesting with a small group of patients the EAPIQ was administered along with the MiniRQLQ, a rhinoconjunctivitis instrument developed by Juniper et al., in a randomized clinical trial studying a new ocular allergy treatment (300 US patients). To facilitate global use, we tested the EAPIQ with 48 allergy patients in 4 European countries, followed by focus groups to gain input on relevance of items and satisfaction with EAPIQ administration. RESULTS: Face validity was demonstrated in the initial pretest of the questionnaire. Modifications were made for use in the clinical trial. Many items (e.g. limitation reading and driving, days symptoms interfered with leisure activities) on the EAPIQ were found to correlate with patient reports of symptoms (itching) and the mRQLQ. European patients generally felt the EAPIQ addressed their concerns and suggested few changes to the questionnaire, including reducing the number of redundant items and standardizing the scaling options. The 48 participants had a mean age of 37 years and 52% were female. 78% reported use of allergy treatments 2-3 times daily. The most bothersome symptoms were itchy eyes (52%) and watery eyes (23%). Most patients felt irritable, embarrassed or self-conscious a "good-bit-of time" due to their eye allergy symptoms. CONCLUSION: The EAPIQ is a disease specific instrument that captures and addresses the symptomatic, outcomes, and QOL concerns of patients suffering from seasonal and chronic ocular allergy symptoms. A revised-final version of the EAPIQ is currently undergoing testing in a multinational validation study.