Objective: To evaluate the efficacy of topical anesthesia and topical + intracameral anesthesia in phacoemulsification of different opacity grade cataracts. Material and Methods: 128 patients underwent with phacoemulsification and foldable intraocular lens implantation. The patients were divided into two groups: topical anesthesia only (n=64) and topical + intracameral anesthesia (n=64) with preservative free 1% lidocaine added to the infusion solution. Cataract opacity grade, intra-operative and immediate post-operative pain as well as vital signs were recorded. Results: Mean age of 68.4 years ± 2.7 D (49-90), 67 females (52.34%) and 61 males (47.66%). Cataract opacity grades were as follows: II (18%), III (61.7%), IV and greater (20.3%). Thirteen patients experienced mild pain: 9 (7%) in the topical anesthesia group during nuclear rotation and 4 (3%) in the topical + intracameral anesthesia group during insertion of the phaco needle into the anterior chamber. (p= 0.14) Vital signs were stable. Conclusion: Topical anesthesia is both safe and effective in phacoemulsification. Topical + intracameral anesthesia is more appropriate for cases with cataracts of greater density. RESUMEN Objetivo: Evaluar la efectividad de la anestesia tópica sola y anestesia tópica e intracameral en diferentes grados de cataratas tratadas con facoemulsificación. Material y Método: Se revisaron 128 pacientes con catarata y sometidos a facoemulsificación e implante de lente intraocular plegable. Se dividieron en dos grupos: grupo de anestesia tópica (n=64) y grupo de anestesia tópica e intracameral (n=64) con lidocaína al 1% libre de conservadores administrada a la infusión de irrigación. Se registraron tipo de catarata, dolor trans y post operatorio inmediato y signos vitales. Resultados: La edad media fue de 68.4 ± 2.7 D (49-90), 67 mujeres (52.34%) y 61 hombres (47.66%). Las cataratas se distribuyeron en los siguientes grados: II (18%), III (61.7%), IV y mayor (20.3%). Trece pacientes presentaron leve dolor, 9 (7%) del grupo con anestesia tópica al rotar el núcleo en cataratas grado IV y 4 (3%) en el grupo de tópica e intracameral, durante la introducción de la pieza de mano a la cámara anterior. (p=0.14) Signos vitales eran estables. Conclusión: La anestesia tópica es segura y efectiva en facoemulsificación, la anestesia tópica e intracameral es mejor en casos de catarata de mayor densidad