Among ocular infections, trachoma is the main cause of blindness. Repeated conjunctival Chlamydia trachomatis infections lead to trichiasis, corneal opacification and visual impairment. Surgery is often needed to relieve discomfort and preserve vision. However, a high recurrence rate is observed. There are many hypotheses that may explain this high failure rate. We systematically reviewed the literature on the pathogenesis and clinical features of postoperative trachomatous trichiasis (PTT) and the evidence for interventions to prevent and manage it.