Rail fasteners are critical components in high-speed railway. Therefore, they are inspected periodically to ensure the safety of high-speed trains. Manual inspection and two-dimensional visual inspection are the commonly used methods. However, both of them have drawbacks. In this paper, a rigorous high-speed railway fastener inspection approach from structured light sensors is proposed to detect damaged and loose fasteners. Firstly, precise and extremely dense point cloud of fasteners are obtained from commercial structured light sensors. With a decision tree classifier, the defects of the fasteners are classified in detail. Furthermore, a normal vector based center extraction method for complex cylindrical surface is proposed to extract the centerline of the metal clip of normal fasteners. Lastly, the looseness of the fastener is evaluated based on the extracted centerline of the metal clip. Experiments were conducted on high-speed railways to evaluate the accuracy, effectiveness, and the influence of the parameters of the proposed method. The overall precision of the decision tree classifier is over 99.8% and the root-mean-square error of looseness check is 0.15 mm, demonstrating a reliable and effective solution for high-speed railway fastener maintenance.