Although we recently compared blood pressure (BP) changes during cataract surgery between groups that received topical and retrobulbar block anesthesia, a study has not been conducted in which patients were matched for age and sex. To draw more meaningful conclusions, we conducted a age- and sex-matched study in which the daily, pre- and postoperative blood pressures of 1,398 cataract patients were compared. All surgeries were performed using the same method of phacoemulsification and aspiration with intraocular lens implantation under local anesthesia. The postoperative BPs of the retrobulbar injection group decreased significantly more than the topical application group. Even when the patients were hypertensive, the postoperative BPs decreased. Following retrobulbar block anesthesia, the BP decreased postoperatively to a greater extent than after topical anesthesia.