Abstract: Chiral carbon dots (CCDs) are a new type of carbon based nanoluminescent material that introduces chiral structures or chiral superstructures on the basis of traditional carbon dots. They combine the excellent optical properties of carbon dots with chiral optical response, and have broad application prospects in chiral recognition, biological imaging, and biomedical engineering. Based on the main theme of “controlled synthesis”, this article summarizes the structural characteristics and optical basis of chiral carbon dots, systematically sorts out several main synthesis strategies such as direct carbonization of chiral precursors, surface chiral modification, and chiral template/supramolecular self-assembly, and focuses on discussing the key regulatory parameters that affect the luminescence wavelength, quantum yield, and chiral asymmetry factor (g value). In the section on biological applications, the representative progress of chiral carbon dots in cell imaging, chiral selective sensing, chiral electrochemical interface construction, etc. is introduced, and their potential applications in drug delivery, chiral phototherapy, and bioinformatics encoding are briefly reviewed. Finally, the main problems currently existing are analyzed from the perspectives of structure performance structure-activity relationship, synthesis repeatability, long-term safety, and interdisciplinary collaboration. The possible paths to promote chiral carbon dots towards higher-level biological applications through precise molecular design, green sustainable precursors, multimodal imaging and treatment integration are also discussed.