Although vitamin E has been known as an essential nutrient for almost 80 years, we are far from a complete understanding of all the aspects related to bioavailability and its effects on health and milk quality in dairy cows. Vitamin E is a generic descriptor for two families of lipid-soluble compounds, the tocopherols and the tocotrienols, of which α-tocopherol has the highest biological activity. Commercially available α-tocopherol supplements for dairy cows contain either the natural RRR form or the synthetic (all-rac) form, which contains all the eight possible stereoisomers (four possessing the 2R and four possessing the 2S configuration) in equimolar amounts. Recent data clearly suggest that an almost complete discrimination against the 2S isomers occurs in dairy cows. Thus, 1 g of the all-rac form is essentially equivalent to 0.5 g of the RRR form. With respect to the effect of vitamin E supplementation of dairy cows on health and milk quality, the majority of published studies suggests that vitamin E supplementation at the level 1000 to 4000 IU/cow per day during the dry period reduces both the frequency of intramammary infection and that of clinical mastitis and improves milk quality, as shown by a reduction in the levels of somatic cell count (SCC)/ml in milk, decreased plasmin activity and increased oxidative stability of milk. However, a recent study from the Netherlands suggested that vitamin E supplementation at the 3000 IU/cow per day level during the dry period when combined with high levels of plasma vitamin E at dry-off (>14.5 μmol/l) increases the incidence of mastitis. Data from previously unpublished survey studies and those from published vitamin E feeding trials, in which high levels of blood vitamin E were observed, were reanalyzed. All farms selected for the analysis implemented oral administration of vitamin E at the 3000 IU/cow per day level throughout or during the late dry period (4 weeks before the expected day of parturition). Dairy cows were divided into three groups, depending on blood α-tocopherol levels at dry-off: high (>6.25 μg/ml), medium (between 6.25 and 4.25 μg/ml) and low (<4.25 μg/ml). Data indicate that there were no differences in the incidence of mastitis and in the level of SCC/ml of milk between the three groups. Thus, supplementation of 3000 IU vitamin E/cow per day in the late dry period remains recommended because it is generally associated with decreased risk of mastitis. Conditional or opposite effects have not been repeated and require further research before changing recommendations for vitamin E supplementation.