Exosomes are nanovesicles actively secreted by cells, which selectively encapsulate biologically active molecules such as proteins, RNA, and cytokines. They play an important role in intercellular communication, immune regulation, and maintenance of homeostasis, which can also be used as carriers for targeted drug delivery. Retinal ischemia-reperfusion injury (RIRI) is a retinopathy that seriously threatens human vision. At present, the clinical treatment of these diseases are symptomatic treatments, and some patients have poor efficacy or even blindness. As extracellular vesicles rich in functional proteins and RNAs, exosomes can not only be used as drugs for the treatment of RIRI, but also be used as carriers for drug delivery to play synergistic therapeutic effects. In the future, with the deepening of the research on the molecular structure, contents and biological functions of exosomes, as well as the continuous development of ophthalmic biology and genetic engineering technology, exosomes are expected to exert their great potential as therapeutic drugs and carriers, and become an important means of treating RIRI.