A key component of elimination is to reduce the number of unmanaged trachomatous trichiasis cases to less than 1 per 1,000 population in affected areas. This will require not only a large increase in the number of surgeries performed, but also improvements in the quality of surgery and in the efficiency of surgery provision programs. It also will require that we make special efforts to reach out to women and the most marginalized populations, who are disproportionally affected by trichiasis (TT).