Approximately 8 to 10 million new cases of xerophthalmia due to vitamin A deficiency occur each year, with as many as ½ to 1 million children developing potentially blinding corneal disease. While vitamin A deficiency is the leading cause of blindness among children in developing countries, even milder states of deficiency carry an increased risk of morbidity and mortality, making its prevention a major public health priority. Three basic preventive strategies exist: (1) dietary modification through a variety of horticultural and nutrition education techniques to increase the routine availability and consumption of food sources of vitamin A, (2) fortification of a centrally processed, locally available and consumed food “vehicle” with vitamin A, and (3) periodic administration of a large dose of vitamin A to specific target groups in the community. This paper provides a critical review of the effectiveness of and challenges to management in implementing periodic, large‐dose vitamin A delivery. Current evidence indicates that programs that are well supervised and sustain at least 65% coverage of their “at risk” populations can expect to have a measurable impact on the occurrence of xerophthahnia among children in the community.