Dry eye disease (DED) is a common complication following refractive surgeries such as small incision lenticule extraction (SMILE), laser-assisted in situ keratomileusis (LASIK), and PRK, significantly impacting patient satisfaction. The primary cause of DED is the transection of corneal nerves during surgery, which disrupts the cornea-blink reflex, reduces tear secretion, and destabilizes the tear film. SMILE, performed exclusively with a femtosecond laser, demonstrates a lower and less severe incidence of DED compared to LASIK and PRK, with faster recovery and fewer patients requiring tear supplements postoperatively. LASIK, involving flap creation, causes significant corneal nerve damage, leading to higher DED rates (36–75%), with symptoms persisting in 8–48% of patients up to 6 months post-surgery. PRK, which avoids flap creation, shows a lower incidence of DED (37%) and less severe nerve damage than LASIK. SMILE, with its minimal anterior stromal nerve disruption, preserves corneal sensation better and results in faster re-innervation. Management of postoperative DED includes topical lubricants, lid hygiene, and, in severe cases, steroid therapy or cyclosporin. Inflammation, changes in corneal curvature, and preservative-containing eye drops can exacerbate DED. Preventive measures and tailored surgical techniques, such as minimizing nerve damage, are crucial for reducing DED incidence and improving patient outcomes.