AIM: To report the intraoperative complications associated with small incision lenticule extraction (SMILE) and their management. METHODS: This was a retrospective consecutive interventional clinical study, carried out on patients with myopia and myopic astigmatism, who underwent SMILE procedure. Type of intraoperative complications and their management were recorded. RESULTS: Our study comprised 282 eyes of 141 patients who were enrolled for SMILE surgeries. The intraoperative complications included lost vacuum (18 eyes, 6.38%), treatment decentration (6 eyes, 2.12%), wound bleeding (21 eyes, 7.45%), incomplete bubble separation (black islands) (3 eyes, 1.06%), the epithelial defects (15 eyes, 5.32%). Incision tear (27 eyes, 9.57%), lenticule adherence to the cap (6 eyes, 2.12%), and cap perforation occurred in 2 eyes (0.7%). CONCLUSION: Although SMILE is a promising technique for the correction of myopia and myopic astigmatism with predictable, efficient, safe refractive and visual outcomes, complications can occur. However, most of them are related to inexperience and are included in the learning curve of the technique. More studies with a bigger number of eyes are required to efficiently evaluate the intraoperative complications and standardize their management strategies.