Aim: A comparison of patient pain and visual outcome using topical anesthesia versus regional anesthesia during cataract surgery. Methods: This comparative study was done at the Department of Ophthalmology, Patna Medical College and Hospital, Patna, Bihar, India for 13 months and patients enrolled for the study were operated at Drishtikunj Netralaya, Patna and Phulwari Eye Hospital, Patna. Results: 100 patients (mean age 73.5±7.2 years) received topical anesthesia, 100 patients (mean age 70.5±9.4 years) received sub-Tenon anesthesia, and 100 patients (mean age 71.5±8.8 years) received intracameral anesthesia. There was a significant difference in mean age between the topical group and sub-Tenon group (P=0.032). The mean pain score on the visual pain scale in the sub-Tenon group was significantly lower than that in the topical group (P=0.0007) and in the intracameral group (P=0.0051). There were no statistical differences in mean pain score between the topical and intracameral groups (P=0.85). In our study, 70 patients received bilateral cataract surgery and 115 patients received unilateral surgery. The mean pain score was 0.435 in 70 eyes of 70 patients who received bilateral surgery and 0.478 in 115 patients who received unilateral surgery. There was no significant difference in mean pain score between the two groups (P=0.44).50 patients showed high myopia (>-6D). In 50 myopic eyes, there were no significant differences in age, duration of surgery, visual acuity, and mean percentage of corneal endothelial cell loss between the three groups (topical, sub-Tenon, and intracameral). The mean pain score in the sub-Tenon group was significantly lower than that in the topical and intracameral groups (P=0.0027 and P=0.0022, respectively). However, in 250 eyes without high myopia (<-6D), there were no significant differences in mean pain score between the sub- Tenon and intracameral groups (P=0.15). Conclusion: Intracameral lidocaine provides sufficient pain suppressive effects in eyes without high myopia, while sub-Tenon anesthesia is better for cataract surgery in eyes with high myopia.