Purpose: Manual small-incision cataract surgery (MSICS) has a major role in tackling cataract blindness in our country. Cauterization of sclera is one of the important steps performed in MSICS to have bloodless field during surgery. Only few studies have addressed the effect of cautery on post-operative astigmatism. The present study is designed to evaluate the effect of cautery on surgically induced astigmatism in Indian patients. Methods: The study was designed as a prospective randomized trial conducted in a tertiary health care institution over a period of 2 years. A total of 150 eyes were randomized into two groups. The study group (Group 1, n = 75) underwent MSICS with cauterization using wetfield bipolar cautery with 4 amperes power. In the control group (Group 2, n = 75), no cauterization was performed. Surgically induced astigmatism was calculated using Naesers polar value method and compared between these two groups up to 60 days post-operatively. Results: Data from 150 eyes were available for evaluation. The net post-operative astigmatic value was 1.01 ± 0.21, 1.04 ± 0.19, and 1.03 ± 0.22 D on the 1 st , 7 th , and 30 th post-operative days, respectively, showing a stable trend in patients undergoing cauterization. In Group 2, the net post-operative astigmatic values observed were 0.47 ± 0.11 D, 0.54 ± 0.10, and 0.54 ± 0.09 D on the 1 st , 7 th , and 30 th post-operative days, respectively. The mean value of surgically induced astigmatism at 2 months post-operatively with and without cautery was 0.60 ± 0.20 D at 90° and 0.47 ± 0.10 D at 90°. The difference was not statistically significant ( P = 0.08). Conclusion: The results of this study show that the use of cautery in MSICS is not associated with a higher surgically induced post-operative astigmatism. The magnitude of surgically induced astigmatism decreases with time.