In this paper we analyze metastability and nucleation in the context of a local version of the Kawasaki dynamics for the two-dimensional strongly anisotropic Ising lattice gas at very low temperature. Let $\Lambda\subset\mathbb{Z}^2$ be a finite box. Particles perform simple exclusion on $\Lambda$, but when they occupy neighboring sites they feel a binding energy $-U_1<0$ in the horizontal direction and $-U_2<0$ in the vertical one. Thus the Kawasaki dynamics is conservative inside the volume $\Lambda$. Along each bond touching the boundary of $\Lambda$ from the outside to the inside, particles are created with rate $\rho=e^{-\Delta\beta}$, while along each bond from the inside to the outside, particles are annihilated with rate $1$, where $\beta$ is the inverse temperature and $\Delta>0$ is an activity parameter. Thus, the boundary of $\Lambda$ plays the role of an infinite gas reservoir with density $\rho$. We consider the parameter regime $U_1>2U_2$ also known as the strongly anisotropic regime. We take $\Delta\in{(U_1,U_1+U_2)}$ and we prove that the empty (respectively full) configuration is a metastable (respectively stable) configuration. We consider the asymptotic regime corresponding to finite volume in the limit of large inverse temperature $\beta$. We investigate how the transition from empty to full takes place. In particular, we estimate in probability, expectation and distribution the asymptotic transition time from the metastable configuration to the stable configuration. Moreover, we identify the size of the \emph{critical droplets}, as well as some of their properties. We observe very different behavior in the weakly and strongly anisotropic regimes. We find that the \emph{Wulff shape}, i.e., the shape minimizing the energy of a droplet at fixed volume, is not relevant for the nucleation pattern.