The purpose of this review is to provide the reader with an overview of the advances made in ocular delivery of bioactive molecules by means of chitosan-based nanosystems, and their potential relevance in clinical use. The studies described clearly emphasise that chitosan-based nanostructures are versatile systems that can be tailor-made according to required compositions, surface characteristics and particle size. Such parameters, which are known to influence their in vivo performance, can be modulated by adjusting the formulation conditions of the nanotechnologies responsible for their formation, by incorporating additional materials in the preparation steps, and/or by using synthetically modified chitosan. Moreover, this review illustrates how the advances achieved in the understanding of the interaction of nanosystems with the ocular structures should result in the coming years, logically, into challenging innovations in ocular nanomedicines with significant impact on clinical practice.