A randomized clinical trial study was conducted to compare the success rates of two surgical methods: Bilamellar Tarsal Rotation (BTR) and Tarsotomy (Transverse Tarsotomy and lid margin Rotation = TTR) for trachomatous trichiasis of the upper lid; where success was defined as no lash/eyeball contact in all positions of gaze, complete lid closure, no under or over correction. The study was conducted at Minellik II Hospital, Addis Ababa. Two hundred fifty six upper eyelids of 153 patients with entropion/trichiasis related to trachoma were enrolled in the two groups. Patients were randomly allocated for the BTR (124) and TTR (132) procedures. Out of these, 237 (92.6%) came for the third month follow-up. One hundred fifteen (48.5%) lids underwent BTR and the remaining 122 (51.5%) underwent TTR. In total, from 141 patients who came for the last follow up, 109 (77.3%) were females. BTR procedure was found to be successful in 25 (86.2%) of the eyelids with minor trichiasis and 74 (86.0%) of those with major trichiasis; the difference between patients who had had minor and major trichiasis (X2 = 0.08, P = 0.772) was not statistically significant. TTR was successful in 39 (95.1%) of the eyelids with minor trichiasis and 68 (84.0%) of those with major trichiasis, again no statistically significant difference was observed for minor and major trichiasis (X2 = 3.15, P = 0.379). There was no statistically significant difference in recurrence between BTR and TTR (X2 = 0.14, P = 0.711). Complications such as lid-notching, pyogenic granuloma, etc. were observed more in BTR than in TTR and this was statistically significant (X2 = 9.54, P = 0.002). In conclusion, the results show that TTR is equally successful in minor and major trichiasis and has fewer complications than BTR at three months of follow-up.