Objective To evaluate the effect of remazolam combined with remifentanil for general anesthesia in patients undergoing ophthalmic surgery. Methods A total of 80 patients, American Society of Anesthesiologists (ASA) Ⅰ or Ⅱ grade, aged 50‒70 y, men or women, body mass index (BMI) 18‒30 kg/m2, who were scheduled for ophthalmic surgery were enrolled. According to the random number table method, the patients were divided into two groups (n=40): a propofol combined with remifentanil group (group P) and a remazolam combined with remifentanil group (group R). Anesthesia induction: group P was intravenously injected with propofol at 2 mg/kg, while group R was intravenously injected with remazolam at 0.2 mg/kg. Both groups were administered with 30 μg/kg afentanil. When the patients became unconscious, 0.2 mg/kg cisatracurium was given and laryngeal mask was inserted. Anesthesia maintenance: group P was intravenously infused with propofol at 6‒10 mg·kg−1·h−1, while group R was intravenously infused with remazolam at 0.4‒1.2 mg·kg−1·h−1. Both groups were intravenously infused with remifentanil at 0.1‒0.2 μg·kg−1·min−1, with intravenous injection of cisatracurium in an intermittent manner. Bispectral index (BIS) value was maintained at 50‒60 and hemodynamics was stable during surgery. Then, their operation time, anesthesia time, infusion volume, intraoperative dosage of remifentanil, the time to loss of consciousness, the time to the recovery of consciousness, the time of laryngeal mask removal, the length of post‑anesthesia care unit (PACU) stay, the occurrence of intraoperative hypertension, hypotension, tachycardia, bradycardia, and the use of vasopressor drugs were recorded. The occurrence of injection pain, postoperative adverse reactions such as hypoxia, drowsiness, nausea and vomiting, as well as the occurrence of intraoperative awareness and remedial analgesia were recorded. Results Compared with group P, there were no statistical differences in the time to loss of consciousness, the time to the recovery of consciousness, the time of laryngeal mask removal, and the length of PACU stay in group R (P>0.05). Compared with group P, group R showed decreases in the incidence of hypotension and bradycardia (P<0.05), and increases in the use of intraoperative antihypertensive agents (P<0.05), with a reduced incidence of injection pain during anesthesia induction (P<0.05). No intraoperative awareness occurred in the two groups, while no remedial analgesia was needed. There was no statistical difference in the incidence of postoperative adverse reactions between the two groups (P>0.05). Conclusion Remazolam can be used in combination with remifentanil for anesthesia in patients undergoing ophthalmic surgery in a safe and effective manner.