Sjögren's syndrome (SS) is an autoimmune disease characterized by the destruction of the structure and function of exocrine glands (EGs) such as lacrimal glands (LGs) and salivary glands (SGs). During the pathogenesis, various immune cells such as lymphocytes, dendritic cells, and macrophages are activated, which together maintain the pro-inflammatory environment of the EGs. As an important immune cell linking innate and specific immunity, macrophages have both functions of phagocytosis and antigen presentation. Studies in animal models and SS patients have suggested that macrophages play an important role in the clearance of apoptotic cells and the activation of lymphocytes in the EGs of SS patients. This narrative review highlights the roles of macrophages in the development of SS, with the aim of providing a comprehensive reference for future research.