PURPOSE: International and national programs to control vitamin A deficiency disorders (VADD) among children in developing countries are reducing the magnitude but VADD still occurs in deprived populations. The purpose of the study was to estimate the prevalence of and identify risk factors for xerophthalmia in children aged 6-71 months living in slums in Pune, India in 2003. METHODS: Children were enrolled into a cross sectional study from randomly selected Anganwadis (kindergartens) in selected slums using proportional to size sampling. Parents/caregivers were interviewed by social workers about night blindness, risk factors for VADD at individual and household levels, intake of vitamin A rich foods, and history of vitamin A supplementation. Children were examined for signs of xerophthalmia by an ophthalmologist. Risk factors for xerophthalmia were explored using univariate and multivariate regression analysis. RESULTS: 1,589 children were examined (response rate 80.2%) 22 of whom had xerophthalmia, prevalence 1.32% (95% confidence interval [CI] 0.76-1.88%). There were no gender differences. Independent risk factors for xerophthalmia were having an illiterate mother [Odds ratio [OR]15.4 (95% CI 4.4-64.1)] and lack of a safe water supply [OR 6.11, 95% CI 2.5-5.1)]. Only 11.3 and 13.3% of children in different slums had taken vitamin A supplements. CONCLUSIONS: Xerophthalmia was at a level of public health significance in children living in slums in Pune. This study highlights the importance of female education and indicates that vitamin A supplementation and other approaches to control need to be improved in children living in deprived areas like urban slums.