Purpose: This study aims to compare the efficacy and patient comfort associated with subconjunctival lignocaine versus topical paracaine with intracameral lignocaine in small incision cataract surgery (SICS). Methods: A comprehensive review of existing literature was conducted, including randomized controlled trials, prospective studies, and systematic reviews. Databases such as PubMed, Scopus, and the Cochrane Library were searched to identify relevant studies. The primary outcomes analysed were anaesthesia efficacy, patient comfort, need for supplemental anaesthesia, and complication rates. Results: The analysis revealed that subconjunctival lignocaine generally provides superior anaesthesia for SICS, particularly in cases involving dense cataracts or extended surgical duration. However, topical paracaine with intracameral lignocaine was preferred by many patients due to its less invasive nature, leading to higher comfort levels and reduced anxiety. Despite this, the topical-intracameral approach demonstrated a higher likelihood of requiring supplemental anaesthesia. The incidence of subconjunctival haemorrhage was more common with subconjunctival lignocaine, whereas the topical-intracameral method had fewer complications overall. Discussion: The review highlights the importance of considering patient-specific factors when selecting an anaesthetic technique for SICS. While subconjunctival lignocaine is more effective for deeper anaesthesia, the topical-intracameral combination may be more suitable for needle-averse patients or those with high anxiety. The study also identifies the need for standardized outcome measures and longer follow-up periods in future research to better evaluate the long-term outcomes and potential complications associated with these techniques. Conclusion: Both anaesthetic methods have their advantages, and the choice between them should be individualized based on the patient's preferences and clinical needs. Future studies should focus on standardizing evaluation criteria and extending follow-up to provide clearer guidance on the optimal anaesthetic approach for SICS.