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Background The relationship between gout medication use and cataract development is controversial. Moreover, limited clinical studies have evaluated this relationship. Aim To assess the effects of colchicine, allopurinol and benzbromarone on the risk of cataract in patients with gout. Design Population-based nested case–control study. Methods We enrolled 7900 patients who had received a new diagnosis of cataract >3 years after gout diagnosis into the study group and 33 475 patients who did not receive a diagnosis of cataract into the control group by matching for age, sex and the year of gout diagnosis at a ratio of 1:1. We used World Health Organization's defined daily dose (DDD) as a measure to assess the dosage of colchicine, allopurinol and benzbromarone exposure. Logistic regression was used to estimate crude and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the risk of cataract. Results The risk of cataract significantly increased in patients who received colchicine at a cumulative DDD of ≥66.5 (OR = 1.17, 95% CI = 1.01–1.36, P  = 0.041). In the age-stratified analysis, patients with gout aged >60 years had a higher risk of cataract (OR = 1.27, 95% CI = 1.06–1.53, P  = 0.011) than did patients aged <60 years. Allopurinol and benzbromarone had no association with cataract. Conclusions In this population-based nested case–control study, we observed that colchicine use increased the risk of cataract in patients with gout, especially in those aged >60 years who received colchicine at a cumulative DDD of >66.5. [ABSTRACT FROM AUTHOR]