Conventional treatments for dry eye disease, such as artificial tears and anti-inflammatory drugs, can only alleviate symptoms, and it is difficult to achieve etiological repair with these treatments. In recent years, stem cell and exosome-based therapies have emerged as promising research hotspots for dry eye disease treatment, owing to their immunomodulatory, tissue-regenerative, and anti-inflammatory properties. Multiple basic and clinical studies have preliminarily confirmed the therapeutic potential of stem cells and exosomes in treating dry eye disease. This review summarizes recent advances in stem cell and exosome-based treatments for dry eye disease and analyzes their current regulatory landscapes, intending to serve as a reference for investigators within the field.