This systematic review evaluates the practice of task-shifting trichiasis surgery from specialized eye health workers to general health workers in trachoma-endemic countries. It examines surgical outcomes, productivity, and implementation challenges. While generalists can perform surgery with comparable quality to specialists, their productivity remains low due to systemic issues like poor supervision, lack of supplies, and inadequate support. The review emphasizes the need for focused training, better oversight, and dedicated personnel to effectively reduce the burden of trachomatous trichiasis.