Plant-lizard interactions are still poorly studied, despite lizards are known to interact with flowering plants in many parts of the world. They are commonly reported on islands although the number of documented interactions has also increased in mainland, mostly in isolated environments. In this study, we first performed a global review to explore whether lizard-flower and lizard double mutualistic interactions in continents occur in environments similar to those of islands. Then, we aimed at explaining the factors driving the current distribution of such interactions worldwide. To do this, we considered four environmental factors (latitude, altitude, rainfall and temperature), and phylogeny and body size of lizards that may influence flower visitation. Furthermore, we investigated for the first time the functional role (legitimate visit versus florivory) of lizards in plant reproduction and the conditions under which each type of interaction occurs. Finally, we explored the factors influencing the distribution of lizard double mutualisms worldwide. We recorded a total of 452 lizard-flower interactions (ca 3.4% and 0.1% of the extant lizard and plant species, respectively). Lizard-flower interactions were more frequently recorded on islands (79%) regardless of phylogeny and lizard body size, whereas in mainland the number of interactions increased with altitude. Our analyses also revealed that only 20% of all interactions confirmed pollination effectiveness and a strong association of the type of interaction with environmental factors and species traits. Regarding the distribution of lizard double mutualisms, we found a positive effect of island and rainfall, but a decrease in their occurrence with latitude, altitude, temperature and body size. We predict that mutualistic plant-lizard interactions will be increasingly documented, especially in isolated environments (both on islands and continents), which will help us to better understand the biological patterns of this phenomenon and the mechanisms underlying them.