Background:-Postoperative Trichiasis is a significant problem for patients it puts the eye at renewed risk of sight loss. Despite the low utilization of trichiasis surgery and high recurrence rate, evidences that elucidate the prevalence of post operative trichiasis and why it recurs after surgery are limited. Objective:-To assess magnitude and associated factors of Postoperative Trichiasis among adults who undergone trachomatous trichiasis Surgery from January 2018 to December2020 in Ayehu Guagusa District, Northwest Ethiopia.2021. Method:A community-based cross-sectional study was conducted. A total of 403 samples that underwent trachomatous trichiasis from 2018-2020 were selected by lottery method. An interviewer-administered structured questionnaire and document review from destrict health office was used to collect data.Data was entered in epi-data version 4.6 and analysed by SPSS 25. A bivariate logistic regression analysis with a p-value <=0.2 was used to identify content variables for further multivariate logistic regression analysis. A P-value<= 0.05 was declared a statistically significant association between risk factors and dependent variable. Result:In the Ayehu Guagusa district, the prevalence of postoperative trichiasis was 12.1% (CI = 9.1, 15.2). Sex AOR= 3.529(1.283, 9.707), face washing two times AOR = 0.373(0.153, 0.908)), washing the face three or more times AOR=0.385(0.15, 0.985), latrine AOR = 2.131(1.049, 4.331), duration since last surgery AOR=3.495 (1.037, 11.780), and taking Azithromycin after surgery AOR=0.3(0.148, 0.607) and epilation history AOR= 2.62(1.124, 6.109)have a statistically significant association with trichiasis recurrence. ConcussionandRecommendation:The prevalence of postoperative trichiasis was 12.1%which was lower than in most studies conducetd. Sex, frequency of face washing, latrine, medication, epilation history and the time period of last surgery have significant associations with recurrent trichiasis. This finding necessitates: improving residents' hygienic practice and sanitation facility coverage; takingazithromycin medication following surgery. Keywords:Trachomatous Trichiasis, Recurrence,Prevalence,Associated factor, AyehuGuagusa,Ethiopia .