Extraocular bacterial culture was performed in 100 patients with hypovitaminosis A xerophthalmia. There was corneal ulceration in 29 cases and corneal perforation in 22 cases. Eighty-six percent of the patients harbored frankly pathogenic bacteria (46 patients) and potentially pathogenic bacteria (40 patients). All but two patients with either cornal ulceration or perforation harbored potentially pathogenic or frankly pathogenic bacteria. Pseudomonas aeruginosa, Diplococcus pneumoniae, and Moraxella species were isolated in 37% (19 patients) of cases with corneal ulceration and perforation. I cultured P. aeruginosa from 36% (eight patients) of cases with corneal perforation. The many ocular secondary bacterial infections in the early stages of xerophthalmia seem to suggest that bacterial action plays a major role in causing the corneal ulceration and perforation in hypovitaminosis A xerophthalmia.