OBJECTIVE To determine the prevalence of xerophthalmia and the extent of vitamin A deficiency in western Yemen. METHODS A stratified cluster sample of children aged 1-5 years with clinical examination for signs of xerophthalmia as well as blood serum survey. METHODS The 18 districts of western Yemen, of which 10 clusters were chosen at random. METHODS All children aged 1-5 years resident in the cluster sites (n = 2438). METHODS Clinical signs of xerophthalmia, a history of night blindness, serum retinol levels in a random sample of clinically normal children (n =338) in addition to all children with xerophthalmia. RESULTS Night blindness was found in 0.5% of the children, Bitot's spots in 1.7%, corneal ulceration in 0.04% and corneal scars in 0.04% Of the subsample, 7.2% (95% confidence interval [c.i.] 4.4-10.0%) had serum retinol values below 10 micrograms/dl; 63.0% (95% c.i. 57.6- 68.4%) had values below 20 micrograms/dl. CONCLUSIONS Xerophthalmia and vitamin A deficiency are public health problems in western Yemen.