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PURPOSE To assess the risk factors for severe visual impairment (SVI) and corneal complications in primary and secondary Sjogren's syndrome (SS). DESIGN Retrospective case series. METHODS Ocular data of all consecutive SS patients presenting to an eye-care network and diagnosed as per the 2012 American College of Rheumatology criteria over the past eight years were reviewed. MAIN OUTCOME MEASURES The risk factors associated with SVI (best corrected visual acuity< 20/200) and vision-threatening corneal complications (ulceration or perforation) at presentation were evaluated using multivariate analysis and odds ratios (OR). RESULTS Of the 919 patients, 285 (31%) had primary and 634 (69%) had secondary SS. The most common cause of secondary SS was rheumatoid arthritis (98.1%), followed by systemic lupus erythematosus (0.79%), psoriasis (0.79%), and scleroderma (0.6%). Among the 1838 eyes SVI was noted in 10%, and 2.5% had corneal complications at presentation. The presence of corneal scarring (p<0.00001; OR 3.00), corneal ulceration (p< 0.00001; OR 12.96), low Schirmer values (p= 0.0084; OR 0.93), cataract (p= 0.0036; OR 2.4), glaucoma (p=0.04; OR, 4.09) and age at diagnosis (p=0.005; OR 1.02) were independent risk factors for developing SVI. The risk factors for corneal complications were presence of scleritis (p<0.0001, OR=8.9) and a diagnosis of secondary SS (p=0.009; OR=2.94). CONCLUSION In patients with SS, severity of dryness, corneal ulceration and scarring, cataract, and glaucoma are factors associated with poor visual acuity. Eyes with scleritis have a greater risk of developing vision-threatening corneal complications and therefore should be monitored closely.