This study reports a technique in which phacoemulsification and intraocular lens (IOL) insertion are performed in conjunction with a microkeratome flap in a patient with ocular surface disease. Microkeratome-assisted phacoemulsification was performed in a 72-year-old woman with a history of trachoma during childhood. A 130 microm corneal flap was made using a microkeratome prior to phacoemulsification and IOL insertion. Lifting the flap during surgery allowed a clear view of the anterior chamber through the smooth lamellar interface created by the microkeratome blade. The flap was washed and repositioned without sutures at the end of surgery. There were no complications associated with the microkeratome flap following surgery. Visual acuity improved from hand motion to 20/200. Microkeratome-assisted phacoemulsification is a safe technique for cataract patients with diseases of the ocular surface.