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Background Achieving elimination of trachoma as a public health problem in trichiasis-endemic districts requires a systematic approach to trichiasis case finding and outreach. Methods Programme monitoring data from seven countries for 2017–2019 were used to explore the efficiency of different community mobilisation approaches and uptake of trichiasis surgical services. Results Three countries (Ethiopia, Kenya and Mozambique) using broad-based community mobilisation strategies had large numbers of people presenting at outreach but only 2.9% of them had trichiasis, while in four countries (Nigeria, Tanzania, Uganda and Zambia) using house-to-house case finding, 37.5% of outreach attendees had trichiasis. Countries using house-to-house case finding have proportionally more women attending outreach compared with countries using broad-based mobilisation. Among trichiasis cases offered surgery 86% accepted, which was similar for men and women. Conclusions In these settings, house-to-house case finding appears to be a more effective and efficient approach to ensure that trichiasis cases, particularly in women, obtain access to surgical services.