To measure the productivity and factors associated with high productivity of trichiasis surgeons.A standardised, pretested questionnaire was posted to all trichiasis surgeons trained in Tanzania at the address listed at the time of training, and then followed up by post and telephone with those who did not return the form. Questions asked related to place of work, number of surgeries carried out, supplies and equipment available, and outreach activities. A random selection of high-productivity and low-productivity surgeons was invited to a focus group meeting to discuss factors that affected productivity.28 of the trained surgeons had died, retired or could not be located. Forms were retrieved from 95 others. Productivity (averaged over the past 4 years) was low overall, but highly variable. The mean number of surgeries per year was 22.3 (SD 48.1) and the median was 7. The most important factor associated with higher productivity was conducting outreach activities. Conducting outreach was associated with having a complete set of instruments and consumables and with being able to identify a supervisor.Redesigning the provision of trichiasis surgery (in particular, supervision, support and community programmes/outreach) is necessary to ensure that the investment from training is used adequately.