Intraocular infestation by Gnathostoma spinigerum is a rare disease entity, with fewer than 100 cases reported worldwide. To our knowledge, none of the cases reported until now mention a live worm inside the lens. We would like to demonstrate the diagnosis and management of intraocular gnathostomiasis in a 53-year-old male patient who presented to us with pain, redness, and decreased visual acuity in the right eye. Thorough examination revealed cells in the anterior chamber (AC), blurred disc margins, retinal hemorrhages, and a track-like choroidal scar. He was started on empirical therapy. A few days later, he presented with aggravated AC reaction, pigments on anterior lens capsule (ALC), and raised intraocular pressure (IOP). B-scan revealed multiple lens and vitreous echoes. A live worm was observed, embedded within the lens. Small-incision cataract surgery was performed to remove the now-cataractous lens along with the worm. A nick in the ALC facilitated access to the worm, which was skillfully maneuvered out of the lens into the AC and eventually removed in toto using forceps. After a few weeks, once the eye healed, an IOL was placed.