Aim: To compare the degree of surgically induced astigmatism (SIA) following superior or temporal approach in manual small incision cataract surgery among patients in UITH. Methods: A hospital based single blind, prospective and comparative study of surgically induced astigmatism from superior and temporal scleral incisions in manual small incision cataract surgery. Surgeries and follow - up were carried out between April, 2016 and October, 2016. There were 66 eyes recruited, with 3 lost to follow – up. There were 31 eyes in the superior incision approach group and 32 eyes in the temporal incision approach group. The patients were examined on post – operative day 1, week 2, 4 and 8. Visual acuity and keratometry examinations were done. Data was analyzed using SPSS software (version 20). Calculations were performed using surgically induced astigmatism (SIA) calculator version 3.1, a free software program.