OBJECTIVE To evaluate HsS (elastoviscous hylan surgical shield, 0.45%) as an alternative to repeated corneal irrigation with a balanced salt solution during cataract surgery. METHODS York Finch General Hospital, Toronto, Ontario (Center A), and Centre Hospitalier de St. Laurent, St. Laurent, Quebec (Center B), Canada. METHODS This dual-center, randomized, prospective clinical trial comprised 60 patients (40 at Center A; 20 at Center B) who had routine small incision cataract surgery (Center A, endolenticular phacoemulsification; Center B, Khoury manual phacofragmentation) with in-the-bag implantation of a posterior chamber intraocular lens. The corneal irrigating fluid was randomly assigned to be HsS or a balanced salt solution. The frequency of required applications, duration of efficacy of each application, and assessment of corneal moisture, clarity, transparency, and reflection in the HsS and balanced salt solution groups were recorded and compared. RESULTS Mean frequency of applications was 13.9 per procedure in the balanced salt solution group and 1.3 per procedure in the HsS group (P = .0001). Mean duration of effectiveness per application was 23.4 minutes for HsS and 2.0 minutes for balanced salt solution (P = .0001). No significant differences in safety or effect on corneal health were observed between the two solutions. CONCLUSIONS The HsS was significantly more effective than a balanced salt solution in maintaining corneal moisture, clarity, and transparency. The use of HsS may be a safer, more effective option in ophthalmic surgery because it minimizes the obstructed visualization of the surgical field caused by frequent corneal irrigation and loss of surgeon concentration.