Objectives: The objectives of this study were to study the postoperative (postop) outcome of phacoemulsification using iris retractors in patients with small pupils and compare it with well dilating pupils by comparing the final visual acuity, intra- and post-operative complications, endothelial cell count, and anterior chamber (AC) depth of patients with small pupil with those of well-dilated pupil. Materials and Methods: This was a prospective cross-sectional study for December 2020–March 2022 which included 86 eyes of 86 patients. For study purposes eyes were divided into two groups, Group 1 consisted of 43 subjects with post-mydriatic dilatation (≤5 mm), and Group 2 consisted of 43 cases with well-dilated pupils ≥6 mm. Results: Group 1 intraoperatively difficulties faced – incomplete rhexis or runoff (41.86%, n = 43), incomplete nucleus chopping (32.55%, n = 43) and retained cortical matter (46.51%, n = 43) noted, managed by applying iris retractors while group 2 faced no difficulties during surgery. In group 1, 33 patients (76.74%) had no complications. Retained cortex was seen in 5 patients (11.62%) and was the most common complication. In group 2, 41 patients (95.34%) had uneventful cataract surgery while 2 patients (4.64%) had minimally retained cortex on post op day 1. Best-corrected visual acuity (BCVA) – 3 months follow-up was good (Snellen-6/6–6/18, logMar 0.00–0.48) in 90.7% in group 1 and 97.7% in group 2. BCVA was borderline (Snellen 6/24–6/60, logMar 0.60–1.00) in 9.30% in group 1 and 2.32% in group 2. Group 1 mean pre-operative endothelial cell density (2528.44 ± 61.26) in group 2 (2457.05 ± 91.17) was significant. On postop day 1 ,1 week and at 3 months endothelial cell density decreased by 4.27%,7.75%,11.92% respectively compared to preoperative values in group 1 while in group 2 it decreased by 2.20%,3.84%,5.40% respectively compared to preoperative values. AC depth was shallower (2.49 ± 0.39) in patients in which complication was noted compared to AC depth (2.72 ± 0.41) in which there was no complication, P value being 0.010 is significant. Conclusion: Small pupil poses some difficulty in cataract surgery which can be overcome by timely intervention by expert surgeons and complication rates can be minimised.