Abstract: To evaluate and compare intraoperative pain, perioperative complications and hemodynamic changes during phacoemulsification under topical and retrobulbar anesthesia. A total of 564 patients were randomly allocated into topical and retrobulbar groups. All patients received 2 mcg kg-1 fentanyl 5 min before the start of their procedures. Patients in the topical group were treated with tetracaine 0.5% eye drops and given preservative free lidocaine 2% intracamerally during surgery. Patients in the retrobulbar group received a 4 mL lidocaine 2% into the retrobulbar space. The number of complications, hemodynamic changes, phaco time and pain severity on the base of a 10-point visual analog scale of pain were recorded immediately after surgery. Differences between the 2 study groups in age, sex, postoperative visual acuity and phaco time were not statistically significant. Blood oxygen saturation, heart rate, systolic and diastolic blood pressure had no difference before and after surgery in the two groups (p>0.05). Chemosis, periorbital hematoma and subconjunctival hemorrhage occurred only in the retrobulbar anesthesia group. Incidence of vitreous loss, corneal edema and zonular tear was not statistically significant in the two groups. Two hundred thirty five patients (83%) in the retrobulbar and 238 (84%) in the topical group reported minimal discomfort (0-2). The Mean±SD pain score in the topical group was 1.13±1.36 and in the retrobulbar group 1.14±1.47 (p = 0.92). Patients undergoing cataract surgery with topical anesthesia and those undergoing cataract surgery with retrobulbar block did not vary in terms of subjective pain score and other parameters measuring intraoperative pain, efficacy of anesthesia and feasibility of surgery. This suggests that cataract surgery can be performed with topical anesthesia without compromising the safety of the procedure.