Aim: We reviewed retrospectively the indications, surgical techniques and outcomes of punctoplasty surgery for 205 consecutive patients in order to identify factors that influence success. Methods: We identified all patients who underwent punctoplasty surgery from April 2002 to June 2006 within the Royal Berkshire NHS Trust, UK. No patient had an additional procedure simultaneously. Hospital records were used to ascertain the proportion of patients who were appropriately assessed preoperatively, the anatomical and functional success rates for surgery and the patient satisfaction rate. We assessed the influence of surgical technique, grade of operating surgeon and the use of postoperative topical medication on these outcomes. Results: Eighty-two per cent of patients had an appropriate preoperative assessment. Amongst these, the anatomical and functional success rates for punctoplasty surgery were 91% and 64%, respectively. The patient satisfaction rate was 71%. The grade of surgeon did not significantly affect outcome of punctoplasty (p = 0.4). The use of topical steroids postoperatively did not significantly improve surgical outcome (p = 0.7). There was no significant difference in anatomical success between a two-snip versus a three-snip punctoplasty technique (p = 0.7). However, in the presence of anatomical success the two-snip procedure gave significantly greater functional success (p = 0.03). Conclusions: This is the largest reported consecutive case series of isolated punctoplasty surgery. Overall anatomical success was high and the surgical technique, grade of surgeon and choice of postoperative medication did not significantly alter the outcome. Without adequate preoperative assessment a significant proportion of patients may undergo surgery inappropriately. Even with an adequate assessment anatomical success is not always followed by resolution of epiphora.