The ocular disease distribution and causes of blindness in the Navajo Indians are discussed. Trauma, usually associated with alcohol ingestion, is the most common cause of monocular blindness. Corneal scars, glaucoma, and retinal detachment are the other leading causes of blindness. Stage IV trachoma is frequently seen in the elderly, but active trachoma is present in only about 1% of Navajo children, a dramatic decline from the past. Pterygium, phlyctenular disease, limbal vernal catarrh, trachoma, pseudoexfoliation of the lens, phakomorphic angle closure glaucoma, iridocyclitis, retinitis pigmentosa, and high corneal astigmatism occur more commonly than in the general US population. Mature cataracts and retinoblastoma may be more prevalent. Acute spontaneous angle-closure glaucoma, unrelated to cataracts, has not been seen. Large pterygia, the most common external problem frequently cause corneal distortion and visual disturbances.