Zeaxanthin is a carotenoid with notable biological activity, demonstrates effective visual protection, antioxidant properties, and anti-tumor effects. However, zeaxanthin is unstable under light conditions and prone to reactions. Furthermore, zeaxanthin cannot be synthesized in the human body and can only be obtained through dietary intake. Based on molecular structure and chemical properties of zeaxanthin, this paper outlines the main extraction process and mechanism of action of zeaxanthin, analyzes the quantitative relationship, advantages, and disadvantages of different extraction processes in extracting zeaxanthin, and focuses on the mechanism of action of zeaxanthin in human cells, including its antioxidant, vision protection, anti-tumor, and other biological mechanisms of action and their interaction regulation. This paper summarizes and prospects the challenges and development trends of zeaxanthin extraction and health product development, providing theoretical references for further understanding the research status of zeaxanthin extraction technology and promoting the development of new functional foods.