Background <p>Extracellular vesicles (EV), especially small EV and microvesicles, are considered promising biomarkers as they transport molecular information from their tissue of origin and can thus reflect pathological processes. They are increasingly being investigated as biomarkers in ocular diseases.</p> Objective <p>The aim of this study was to present the current state of knowledge on the role of EV as biomarkers for ocular diseases, to compare sample sources and to discuss the associated methodological challenges as well as clinical perspectives.</p> Material and methods <p>This work is based on a&#xa0;literature search of current original articles and reviews, complemented by tabular overviews of identified EV-associated markers for ocular diseases.</p> Results <p>The potential of EV as biomarkers for ocular diseases is currently being studied in tears, aqueous humor, vitreous humor, blood and urine. Alterations in EV concentration and size as well as disease-specific signatures have been reported. Numerous EV-associated molecules, particularly microRNA (miRNA) and proteins, have been proposed for diseases such as diabetic retinopathy, age-related macular degeneration, glaucoma, myopia and ocular tumors.</p> Conclusion <p>Although EV hold great promise as diagnostic and prognostic tools in ophthalmology, validated markers and standardized isolation and detection methods are still lacking. Key challenges include lipoprotein contamination, limited sample volumes and interindividual variability (e.g. age, sex, fasting status). In the future, after overcoming these technical challenges, small EV and microvesicles could serve as liquid biopsy tools for screening, disease monitoring and personalized management of ocular diseases.</p>