**Core Concept**
In emergency cataract surgery (ECCE), the choice of irrigating fluid is critical to preserve corneal and lens tissue integrity. The ideal fluid must maintain osmotic balance, minimize oxidative stress, and protect the anterior segment structures during surgery.

**Why the Correct Answer is Right**
Balanced salt solution (BSS) closely mimics intracellular fluid composition, reducing osmotic stress on ocular tissues. Adding glutathione—a potent intracellular antioxidant—enhances protection against oxidative damage during surgery, which is a known contributor to postoperative inflammation and endothelial injury. This combination provides both physiological compatibility and antioxidant support, making it superior to standard saline or lactate solutions in preserving corneal and lens health.

**Why Each Wrong Option is Incorrect**
Option A: Ringer lactate has a higher chloride content than normal serum and may cause osmotic shifts or irritation in the eye.
Option B: Normal saline (0.9% NaCl) has a higher sodium concentration than intracellular fluid and can lead to corneal dehydration or endothelial damage.
Option C: Balanced salt solution is better than normal saline or Ringer lactate, but lacks antioxidant properties, leaving tissue vulnerable to oxidative stress during surgery.

**Clinical Pearl / High-Yield Fact**
In ECCE, the use of BSS + glutathione is recommended in high-risk cases or when preserving corneal endothelium is critical—especially in elderly or diabetic patients with compromised tissue integrity.

✓ Correct Answer: D. Balanced salt solution + glutathione