Advances in cataract surgery techniques have presented surgeons with new options for ocular anesthesia. As cataract removal has become faster, safer, and less traumatic, the need for akinesia and anesthesia has declined significantly. General anesthesia or retrobulbar block have largely been replaced with other safer and equally effective means of local anesthesia. These newer and less invasive methods have reduced the potential for catastrophic surgical complications, increased the efficiency of cataract surgery, and hastened the process of visual rehabilitation. Today there are numerous modes of anesthesia from which a surgeon can choose. This article reviews the current choices for ocular anesthesia, compares their efficacies, and provides a framework, helping to select the most appropriate type of anesthesia for each patient.