Ferroptosis is an iron-dependent, non-apoptotic programmed cell death pattern. So far ferroptosis has been proved to be involved in the pathophysiological mechanisms of many diseases, such as neurodegenerative diseases, ischemia/ reperfusion injury, and tumors. Exosomes, as an intercellular messaging pathway, have been reported to play an important role in regulating ferroptosis process. Meanwhile, exosomes are increasingly used in diseases as a drug delivery vehicle due to low immunogenicity, good biocompatibility, and high efficiency. This article summarizes the regulatory role of exosomes in ferroptosis-related diseases and novel exosome therapeutic strategies targeting ferroptosis.