OBJECTIVE: To evaluate risk factors associated with recurrence after radiofrequency thermocoagulation (RFT) of gasserian ganglion among patients with ophthalmic trigeminal neuralgia (TN) and prognostic factors in terms of recurrence-free survival (RFS) during a long-term follow-up. METHODS: From January 2005 to December 2017, 300 patients with ophthalmic TN underwent RFT. A retrospective analysis of 14-year outcomes was performed. Kaplan-Meier analysis was used for RFS after procedure. Univariate and multivariate Cox regression analysis were performed to identify risk factors for pain recurrence. RESULTS: The initial effective rate of RFT for ophthalmic TN was 92%. The mean follow-up time was 77.38±43.24 months. The cumulative probability of RFS was 86.94% at 1 year, 80.03% at the 2-year, 77.27% at the 3-year, 74.01% at the 5-year and 59.92% at the 10-year after RFT, respectively. The mean duration of RFS was 114.67 (95%CI: 106.27-123.06) months. In multivariate analysis, atypical pain (HR=2.831, 95%CI: 1.759-4.554, p<0.001) and mild facial hypesthesia (HR=2.540, 95%CI: 1.309-4.931, p=0.006) before RFT were independently associated with pain recurrence. Patients with prognostic index (PI) >1.27 were at high-risk for pain recurrence. Major complications included troublesome dysesthesia (0.7%), keratitis (10.9%), diplopia (0.4%), facial paresthesia (6.2%), and masseter weakness (12.7%). Masseter weakness was more common in patients with V3 branch involvement. Three patients lost their sights due to keratitis. CONCLUSION: Our study investigated long-term outcomes and complications of RFT for ophthalmic TN. Patients at high-risk of pain recurrence were identified, which might provide a basis for clinical decision making before RFT. This article is protected by copyright. All rights reserved.