Objective: To evaluate the pattern of recurrence of trachomatous trichiasis (T T) after bilamellar tarsal rotation surgery for trachoma. Design: Observational cohort. Participants: Three hundred eighty-four participants having at least 1 eye that had undergone a single TT surgery a minimum of 18 months before June 20 01. The 630 study eyes were divided equally between left (311) and right (319) e yes. Methods: Patients living in Central Tanzania were identified from surgical lists. Participants were screened for recurrence of TT, including evidence of ep ilation, after surgery. Main Outcome Measures: Detailed information on the locat ion of recurrence was collected, including number of lashes touching the globe a nd location of trichiatic lashes (nasal, central, or temporal). Results: One hun dred seventy-six eyes had evidence of TT recurrence (28%), including 23 eyes h aving recently undergone epilation. In eyes without epilation, left eyes had a h igher rate of recurrence than right eyes (32%vs. 25%; P=0.05). Among eyes with recurrence originating from 1 location, recurrence was highest centrally (40%) . Right eyes had nasal recurrence more often than temporal recurrence (33%vs. 2 0%). Left eyes had temporal recurrencemore often than nasal recurrence (41%vs. 24%). Conclusions: Recurrence of TT after surgery is more common in the left e ye and on the left side of the eyelid. The surgical procedure is more difficult to perform on the right side of the eyelid by a right-handed surgeon. This diff iculty may lead to an unintentional change in surgical technique on the right, w hich may result in lower recurrence on that side. Objective: To evaluate the pattern of recurrence of trachomatous trichiasis (TT) after bilamellar tarsal rotation surgery for trachoma. Design: Observational cohort. Participants: Three hundred eighty-four participants having at least 1 eye that had undergone a single TT surgery a minimum of Methods 630 patients eyes were divided equally between left (311) and right (319) e yes. Methods: Patients living in Central Tanzania were identified from surgical lists. Participants were screened for recurrence of TT, including evidence of epilation, after surgery. Main Outcome Measures: Detailed information on the locat ion of recurrence was collected, including number of lashes touching the globe a nd location of trichiatic lashes (nasal, central, or temporal). Results: One hun dred seventy -six eyes had evidence of TT recurrence (28%), including 23 eyes h aving recently undergone epilation. In eyes without epilation, left eyes had ah igher rate of recurrence than right Of eyes with recurrence originating from 1 location, recurrence was highest centrally (40%). Right eyes had nasal recurrence more often than temporal recurrence (33% vs. 20% Left eyes had transient recurrencemore often than nasal recurrence (41% vs. 24%). Conclusions: Recurrence of TT after surgery is more common in the left e ye and on the left side of the eyelid. The surgical procedure is more difficult to perform on the right side of the eyelid by a right-handed surgeon. This diff iculty may lead to an unintentional change in surgical technique on the right, w hich may result in lower recurrence on that side.