Irrigated agriculture is indispensable to the Lower Mekong River Basin (LMB), which ensures food security and provides livelihoods for tens of millions of people. Irrigation, agricultural production, hydropower and aquatic ecosystem health are intertwined in LMB, so it is necessary to adopt a holistic approach to analyze irrigation problems. Here, we discuss the challenges and opportunities of LMB irrigation. Bibliometric analysis is carried out to determine the characteristics and patterns of watershed irrigation literature, such as the importance of authors, affiliated institutions, and their distribution in China. Based on bibliometric analysis, research topics are determined for thematic review. Firstly, we investigated the factors that directly affect the demand and supply of irrigation water and associated crop yield impacts. Secondly, we analyzed the influence of water availability, land use and climate change on agricultural irrigation. Thirdly, we analyzed the adverse effects of improper irrigation management on the environment, such as flow pattern change, ecosystem deterioration and land subsidence caused by groundwater overexploitation. Fourthly, the time-space mismatch between water supply and demand has brought serious challenges to the comprehensive water resources management in cross-border river basins. In each specific application area, we sorted out the technologies in which remote sensing technology is used. We hope that this review will contribute to in-depth research and decision analysis of remote sensing technology in agricultural irrigation.