In recent years, femtosecond laser small incision lenticule extraction (SMILE) has been one of the mainstream refractive correction surgeries due to its minimally invasive, comfortable, safe and effective advantages. However, similar to other refractive correction surgeries, patients after SMILE surgery also have postoperative dry eye symptoms. In severe cases, they can result in decreased visual quality for patients. Corneal nerve damage during SMILE surgery is the main cause of dry eye. Besides, other pathological mechanisms including generation of inflammatory mediators, reduction of mucin secretion, and meibomian gland dysfunction, etc., result in the reduced secretion of aqueous and lipid layers in tear film and decreased ocular surface lubrication, aggravating the instability of tear film and postoperative dry eye syndrome. This review mainly elaborates on the clinical characteristics and related mechanisms of dry eye after SMILE surgery, and explores the safety and efficacy of SMILE application in patients with dry eye syndrome, in order to provide better visual quality for patients. Lastly, the perioperative prevention and treatment of dry eye syndrome are proposed for patients undergoing SMILE surgery.