Along with the rapidly improving techniques and approaches to cataract surgery, various approaches to anesthesia have evolved. In just a few years, the popularity of general anesthesia gave way to local anesthesia by retrobulbar which in turn, has been increasingly challenged by peribulbar anesthesia and, most recently, by the use of topical anesthesia. Unfortunately, some of these techniques have been published in ophthalmic newsletters or in special interest journals and have not been presented in a manner that can be adequately validated by follow-up and peer review. Cataract anesthetic techniques continue to evolve and as complications are reported with one technique, other methods are tried to achieve the correct balance of efficacy and safety. Today, an increasing volume of data confirms the safety and effectiveness of anesthesia that is localized to the anterior segment.