ABSTRACT Background:- Repeated infection with Chlamydia trachomatis causes Trachomatous trichiasis. Surgery is the preferred method of treatment of Trachomatous trichiasis. Surgery for Trachomatous trichiasis prevents blindness. However people still decline surgery despite the availability of services in nearby health facilities. Objective: - To identify determinants of corrective upper eye lid surgery refusals among Trachomatous trichiasis patients in Mecha woreda, Ethiopia, 2018. Methods: - A community based unmatched case control study design was conducted in Mecha woreda from October 5 to December 17, 2018. A total of 676 study participants with 338 controls and 338 cases were involved in this study. Study participants were selected randomly by lottery method. To collect data, pre-tested structured interviewer-administered questionnaire was used. Independent factors, with a P-value < 0.2 in the bivariate logistic regression was entered into the multivariable logistic regression models. P-value < 0.05 was used as cut-off point for a variable to become significant predictor in multivariable logistic regretion. Results:- Observed bad outcome (AOR: 3.51, 95% CI: 1.94-6.35) and lack of knowledge on trichiasis outcome if untreated (AOR: 1.77, 95% CI: 1.18-2.65) increases refusing to surgery while, having trust to surgeons (AOR: 0.26, 95% CI: 0.15-0.45), knowledge on eye lid surgery (AOR: 0.32, 95% CI: 0.16-0.64), long duration with trichiasis (AOR: 0.5, 95% CI: 0.15-0.45), family member decision maker for own health conditions (AOR: 0.29, 95% CI: 0.13-0.64), epilation more than once per week (AOR: 0.31, 95% CI: 0.17-0.6) and epilation once per week to once per month (AOR: 0.49, 95% CI:0.27-0.86), personal advice from friends, health development army and government body (AOR: 0.26, 95% CI: 0.14-0.5), (AOR: 0.11, 95% CI: 0.04-0.28) and (AOR: 0.46, 95% CI: 0.3-0.7) respectively decreases refuse to surgery. Conclusions:-Long duration with Trachomatous trichiasis, frequently epilation, Knowledge on eye lid surgery, having trust to surgeons, deciding by family member for own health, other person advice decreases refusing to surgery. In the other way Observed bad outcome and lack knowledge on Trichiasis outcome if untreated increases refusing to surgery. Key words:-Trachomatous trichiasis, Corrective upper eye lid surgery refusal, Trachomatous trichiasis treatment, Trachoma, Determinants, Ethiopia