This is the first report of the success rates of frosted Jones tubes with larger diameter, 4.5 or 5mm collars. This is a retrospective review of 29 eyes of 25 patients who underwent insertion of a large diameter collar frosted Jones tube. All but one eye had undergone previous frosted Jones tube placement with either a 3.5mm or 4mm collar. Seven eyes had tubes replaced for loss or outward migration of the existing tube and 21 for a deep seated position. One had a primary large collar inserted due to migration issues in the fellow eye. Of the 25 which had a 4mm tube replaced by a 4.5mm tube, 10 went on to have a 5mm tube. Four tubes were decreased in collar size. Average follow-up after tube replacement was 30 months, with 28 eyes having no epiphora. One patient with complex trauma requested for the tube to be removed for ocular irritation and epiphora, which persisted post-removal. No larger collar tubes were lost, but four patients developed pyogenic granulomas, and two patients with 5mm collars were intolerant of the larger collar. The authors accept that the mechanisms behind tube migration are incompletely understood and that collar size is only one factor. It is still their routine practice to place 4mm collars at initial surgery. Although the study is retrospective it does suggest that a larger 4.5 or 5mm collar should be considered for those patients whose tubes migrate inwards.