We report a severe anaphylactic reaction that occurred about 5 minutes after 1.0 mg of cefuroxime was injected into the anterior chamber after routine phacoemulsification and intraocular lens implantation. The patient was known to be allergic to penicillin. Immediate action was taken, and the patient recovered well. The presence of staff trained in resuscitation was essential in this case and raises questions about the trend to perform routine topical anesthesia cataract surgery without an anesthesiologist in the operating room.