Parts of Dublin and Cork have been heavily criticised
A litter survey by business group Irish Business Against Litter (IBAL) has revealed Fermoy in Co Cork was Ireland's cleanest town in 2018.
While almost all main towns are clean, pockets of cities continue to be littered and are not improving.
Waterford City was again crowned Ireland's cleanest city.
An Taisce, who carry out the surveys on behalf of IBAL, praised Fermoy as having 'exceeded its usual high standards of cleanliness' and adding "great care has been taken not just with regard to litter but also overall presentation."
Fermoy's success, last achieved in 2007, will be marked by a specially commissioned public sculpture in the town this year to the value of €40,000.
Just under 90% of towns surveyed were deemed clean, a slight improvement on the previous year, with Athlone and Killarney finishing just behind Fermoy.
While Galway City registered its best result in years, almost half of city areas were littered, among them Ballybane and Dublin's north inner-city, which were both 'seriously littered'.
Ballymun, Cork's northside and Mahon were littered, while Dublin City Centre was again 'moderately littered'.
Disadvantaged urban areas occupied the bottom five places in the rankings.
Dublin's north inner-city suffered from litter blackspots on Oriel Street, Dunne Street, Sherrard Street Lower and Railway Street.
Fana Glas in Ballybane was a litter blackspot, where "an air of neglect pervaded throughout", with the communal areas 'in very poor condition'.
Ballymun's result was brought down by dumping and burnt items at the former towers and recycle facility at the shopping centre, while the Maples in Mahon in Cork was slammed as "not just littered but subject to dumping with soiled nappies strewn about. There were very heavy levels of all manner of litter throughout."
The report on Cork's northside highlighted the North Ring Road as being 'almost landfill-like' in places and stated "long term littered sites that have been repeatedly highlighted in previous surveys are not being dealt with".
Environment Minister Richard Bruton said: "Combating litter is part of a much wider challenge - how we use our resources effectively and adapt to recognise environmental damage more generally.
"Litter is a very tangible, visible example of the kind of damage that is being done.
"It is vital that communities, businesses and local authorities in towns all across Ireland, work together to manage waste properly and reduce litter.
"I hope the recognition these awards provide spur others on to come together to make changes in their local areas".
Conor Horgan of IBAL added: "Three years ago we deliberately shone a spotlight on specific city areas in the hope that the attention would spur councils and communities into action.
"It is fair to say we have seen no noticeable improvement in any of these areas - nor have we seen much by way of substantial measures to them turn around."
As runners-up, Athlone and Killarney will each receive a number of Norway maple trees to enhance the local environment, courtesy of the Irish Tree Centre in Cork.