Hirudo is highly effective in promoting blood circulation and removing blood stasis, a vital medicine for breaking blood and removing blood stasis in ophthalmopathy. Presently, Hirudo is commonly used in ophthalmology for age-related macular degeneration, diabetic retinopathy, cataract, retinal vein occlusion and other ophthalmic diseases, with the mechanism thereof possibly being related to anti-VEGF, improvement of microcirculation and anti-apoptosis. Further, although new functions have been found in Hirudo extract, such as transdifferentiation and inhibition of WERI-RB-1, these studies remain in the basic exploratory stage, and the specific molecular mechanism requires further verification. This paper concisely describes the application and research status of Hirudo and the extract thereof in ophthalmic diseases, so as to provide a new direction for further research on the treatment of ophthalmopathy using Hirudo and the extract thereof.