Introduction: Anxiety in patients undergoing cataract surgery may lead to increased discomfort and suboptimal surgical outcomes. This study aimed to evaluate the effectiveness of intravenous midazolam as an anxiolytic in patients undergoing cataract surgery under peribulbar block. Methods: In this double-blind, randomized study, 52 patients were assigned to receive either intravenous midazolam (0.02 mg/kg) or saline as a control. Patient and surgeon satisfaction scores, as well as hemodynamic parameters, were assessed and compared between the two groups. Results: Patients in the midazolam group showed significantly higher satisfaction scores (4.6 ± 0.5) than those in the saline group (3.5 ± 0.8) (p < 0.05). Surgeon satisfaction scores were also significantly higher in the midazolam group (4.8 ± 0.4) compared to the saline group (3.2 ± 0.6) (p < 0.05). Hemodynamic parameters, including systolic and diastolic blood pressures, heart rate, and oxygen saturation, were more stable in the midazolam group than in the saline group at various time points throughout the surgery (p < 0.05). Conclusion: Intravenous midazolam administration as an anxiolytic in patients undergoing cataract surgery under peribulbar block led to increased patient and surgeon satisfaction and a more stable hemodynamic profile. These findings support the use of midazolam as an effective and safe adjunct to anesthesia in cataract surgery.