Background & Objectives: As most of the patients posted for cataract surgery belongs to geriatric age group, hypertension and coronary artery diseases (CAD) are more common. Most of the surgeries are performed under local anaesthesia and patients are conscious. This may cause an exaggerated neuroendocrine stress response which is detrimental to patients with compromised cardiac conditions. The aim of our study was to evaluate the hemodynamic and intraocular pressure effects of etomidate in comparison to midazolam during monitored anaesthesia care (MAC) in hypertensive and CAD patients undergoing cataract surgery. Methods: 60 patients posted for cataract surgery under MAC, were randomized into two groups (each of 30): Group E patients were given inj. etomidate 0.1 mg/kg dose and Group M patients were given inj. midazolam 0.03 mg/kg. Both drug were diluted up to 10ml of NS. Ramsay sedation score (RSS) was kept at 3. HR, SBP, DBP, MAP, SpO2, respiratory rate, intraocular pressure, RSS, and complications were recorded at specific time interval till the end of surgery. Results: Mean onset of time for sedation in group E was significantly shorter than group M. Group E produced significant decrease in intraocular pressure than group M. The decrease in HR, SBP, DBP, and MAP were comparable in both groups but the decrease was significant while comparing to baseline. Conclusion: Etomidate achieved adequate depth of sedation in shorter time and produced a significant reduction in intraocular pressure when compared with midazolam. Both drug caused comparable decreased in hemodynamic variables which was within permissible limit.