Background: Pseudoexfoliation syndrome (PXF) is a systemic disorder of elastic fibers that significantly complicates cataract surgery due to zonular weakness and poor pupillary dilatation. Small incision cataract surgery (SICS) remains the predominant technique in resource-limited settings, yet data on outcomes in PXF patients undergoing SICS are limited. This study aimed to evaluate the clinical profile and surgical outcomes of SICS in patients with pseudoexfoliation syndrome. Methods: A retrospective observational study was conducted at a tertiary care center from January 2021 to June 2024. A total of 135 eyes with pseudoexfoliation syndrome undergoing SICS with posterior chamber intraocular lens implantation were analyzed. Preoperative clinical characteristics, intraoperative complications, and postoperative outcomes including best-corrected visual acuity (BCVA) at six weeks were evaluated. Statistical analysis was performed using chi-square test and independent t-test with significance set at p<0.05. Results: The mean age was 67.84±8.42 years with male predominance (58.5%). Poor pupillary dilatation (<6mm) was observed in 34.8% of eyes, and phacodonesis in 25.9%. Intraoperative complications occurred in 17.8% of cases, including zonular dialysis (8.1%), posterior capsule rupture (5.9%), and vitreous loss (3.7%). Capsular tension ring was utilized in 11.1% of cases. At six weeks, 82.2% achieved BCVA ≥6/18. Postoperative complications included corneal edema (28.9%), elevated intraocular pressure (14.8%), and posterior capsule opacification (8.1%). Higher PXF grade and phacodonesis were significantly associated with intraoperative complications (p<0.001). Conclusion: SICS in pseudoexfoliation syndrome patients yields favorable visual outcomes comparable to published literature on phacoemulsification. Thorough preoperative assessment, appropriate use of adjunctive devices, and meticulous surgical technique are essential for optimizing outcomes in this challenging patient population.