Purpose: To evaluate sublingual/oral midazolam in phacoemulsification patients with no intravenous line. Design: prospective, consecutive case series as part of a quality assurance program. Methods:Two surgeons' data from 193 consecutive procedures receiving sublingual plus oral midazolam were analyzed for total midazolam dose, need for additional medications, nausea/vomiting, respiratory depression, and total monitoring time. Low health-risk (American Society of Anesthesiologist 2 (ASA2) and higher health-risk (American Society of Anesthesiologist 3(ASA3)) groups were compared.Results: There were no statistical differences between groups, except ASA2 cases required more midazolam syrup than ASA3 cases (5.94 ± 0.18 vs. 5.08 ± 0.08 mg, p < 0.001). Fewer than 3% of all cases needed additional medication or experienced nausea. Average time monitored was under 80 minutes. One patient had mild (successfully treated) respiratory depression. Only 3 cases required additional syrup, and only 3 intravenous lines were started. There were no intraoperative events. Conclusion:Sublingual/oral midazolam without intravenous line is a safe, efficient complement to topical anaesthesia for phacoemulsification with IOL. PrecisSublingual/oral midazolam without intravenous line is a safe, efficient means of achieving monitored anaesthesia care for phacoemulsification with IOL that offers advantages to both patient and surgeon.