OBJECTIVE To assess the pre-operative management, surgical technique employed, success rate and patient satisfaction following surgery in patients undergoing dacryocystorhinostomy (DCR) in South West England. METHODS Two hundred and forty-two patients who underwent DCR were retrospectively studied. A telephone questionnaire was used to assess patient satisfaction in 100 patients. RESULTS One hundred and thirteen (46%) patients had nasolacrimal duct obstruction, half of whom had a history of dacryocystitis, 70 (29%) had canalicular obstruction and 8 (3%) had mixed blockage. The site of blockage was not known or recorded in 51 patients (22%). Seventy-five (31%) patients underwent DCR, 151 (62%) DCR with insertion of silicon tubes, 9 (4%) DCR and Lester Jones tube, and 7 (3%) canaliculodacryocystorhinostomy (CDCR). Overall an 83.5% success rate was reported by the surgeons. The success rate for patients with a history of dacryocystitis was 98%, for nasolacrimal duct obstruction 96% and for canalicular obstruction 82%. When the site of blockage was not known or recorded the success rate was 60%. Where the name of the surgeon was not recorded there was a 15% successful outcome. Eighty per cent of patients reported some improvement in their symptoms following surgery. CONCLUSIONS DCR is an effective surgical procedure with a high rate of patient satisfaction. Pre-operative identification of the site of the blockage is likely to improve surgical outcome.