Purpose This work aims to evaluate and compare changes in tear meniscus parameters using anterior segment optical coherence tomography (AS-OCT) following the three corneal refractive procedures: Laser-assisted in situ keratomileusis (LASIK), photorefractive keratectomy (PRK), and Femtosecond small incision lenticule extraction (FS-SMILE). Patients and methods A total of 114 eyes from 57 myopic patients were enrolled, with 19 patients in each group. In the first group, patients underwent refractive correction using conventional microkeratome LASIK. In contrast, those in the second group received PRK refractive correction, and those in the third group underwent FS-SMILE refractive correction. All patients had preoperative tear film assessment using anterior segment optical coherence tomography, which was repeated at the first, third, and sixth months postsurgery. Only 52 patients completed at least 6 months of follow-up; 18 from the first group and 17 from each of the second and third groups, and were included in the statistical analysis. Results A substantial reduction in tear film parameters was noted in the three groups during the first month postoperatively. The most severe reduction was noted in the LASIK group, which showed a statistically significant difference when compared with either the PRK or the FS-SMILE group. In contrast, the least reduction was reported in the FS-SMILE group, which returned to near the preoperative levels in the third month postoperatively, with no statistically significant differences between the preoperative and the third or the sixth months’ postoperative tear parameters in the FS-SMILE group. Conclusion FS-SMILE is a safe refractive procedure with less impact on the ocular surface.