If you’re one of the millions of people who have persistently dry eyes, you know that dry eye syndrome can be a nuisance. But the condition, which happens when your tears don’t lubricate your eyes well enough, can be more than just uncomfortable.

Dry eye syndrome sometimes signals an underlying health problem. If left untreated over the long term, it may lead to complications. Here is a list of a few:

• Eye infections
• Eye inflammation
• Corneal abrasions or ulcers (sores)
• Vision loss
• Difficulty reading, driving, or doing other things that require good vision

How do these complications happen? Keep in mind that dry eye happens when your eyes don’t make enough tears to stay wet, or when your tears don’t work the way they should. And tears do more than help you express emotions — they keep your eyes healthy.

For one thing, they protect the surface of your eyes from infections by helping to wash away germs. But if you have dry eye syndrome, your tears don’t do this well enough. So you’re more likely to get eye infections. Eye infections, in turn, can cause complications including permanent vision loss.

Tears also carry away physical irritants like dust, dirt and allergens. So lack of lubrication in your eyes can lead to corneal abrasions (small scratches to the clear outer layer of your eye) or more serious corneal ulcers (sores on your cornea). Without lubrication allergens cause a more severe and frequent reaction.

There’s also a complicated connection between dry eye and eye inflammation.

Inflammation in parts of your eye, like the tear glands, can lead to dry eye. But damage to your cornea caused by dry eye syndrome can lead to more inflammation. That happens when your body sends immune cells where the damage is. So there’s a vicious cycle of inflammation and dry eye that can make the condition worse. This can lead to an Immune mediated response. This is when inflammation causes an alteration in cellular homeostasis. The etiology of this diseases is multifactorial including environmental factors, dietary habits and age. This process will cause tissue injury to the lid and glands due to the excessive inflammatory reaction. This will prime the system making you more susceptible to future flares and progression. When this happens a positive treatment outcome becomes more difficult.