BACKGROUND: Surgery is an important component of the SAFE strategy which has been shown to improve visual acuity. There are limited data on long-term surgical success and patient perceptions and satisfaction. A sample of patients from the Gambia who had undergone previous lid surgery for trichiasis were therefore examined for recurrence of trichiasis and interviewed for patient satisfaction. METHODS: Health centre surgical records and community screening were used to identify patients who had undergone previous lid surgery. Consenting patients were examined and a questionnaire administered. Kaplan-Meier survival plots were constructed for recurrence of trichiasis. RESULTS: Sixty-five subjects were recruited. Median age at surgery was 50 years. Median time since surgery was 7 years. Fifty-two of 115 (45%) operated eyes were free of trichiasis at follow-up and 23 of 65 (35%) patients had not suffered recurrent trichiasis in an operated eye. Median time from surgery to recurrence of trichiasis was estimated as 10.0 years (95% CI 3.7-16.3). Recurrent trichiasis was not significantly associated with visual impairment or blindness at follow-up. The following patient perceptions were reported: satisfaction with surgery (88%), less discomfort than before surgery (93%), improved vision (83%), work easier (38%), worth the expenditure (94%), would recommend it to others (93%), had recommended it to others (38%), experienced intra-operative pain (26%) and experienced post-operative pain (26%). CONCLUSION: Factors affecting surgical success, including surgical technique and re-exposure to infection, are discussed. This study provides important preliminary data for programme planners but larger prospective studies are required.