The clustering of xerophthalmia within households and villages was estimated among preschool age children using data from studies conducted in Malawi, Zambia, Indonesia and Nepal over the past decade. Pairwise odds ratios (OR) were used to measure the magnitude of clustering. This OR measures the risk of xerophthalmia for a preschool child given that another randomly chosen preschool child from the same household (or same village but different household) had xerophthalmia, relative to the risk if that randomly chosen preschool child did not have xerophthalmia. Village pairwise OR ranged from 1.2 in Malawi to 2.2 in Nepal. Household pairwise OR ranged from 4.4 in Malawi to 9.7 in Indonesia, indicating that xerophthalmia clustering was much greater within households than villages. The magnitude of this clustering was as large, or larger than, infectious outcomes such as diarrhoea, fever and cough. Although xerophthalmia was associated with a weekly history of infectious morbidity, the clustering of diarrhoea, fever and cough explained very little of the xerophthalmia clustering observed in each of these studies, Hence, other household factors such as food availability and dietary practices should be examined for their role in the clustering of xerophthalmia within certain households.