Glaucoma is a chronic ocular disorder characterized by elevated intraocular pressure (IOP), leading to progressive optic nerve damage and irreversible vision loss. Pilocarpine, a well-established cholinergic agent, lowers IOP by enhancing aqueous humor outflow; however, its conventional ocular delivery is limited by poor corneal permeability, rapid precorneal elimination, and the need for frequent dosing. These limitations significantly reduce therapeutic efficacy and patient compliance. To overcome these challenges, niosomal gel-based ocular drug delivery systems have emerged as an innovative and effective strategy. Niosomes are non-ionic surfactant-based vesicular carriers capable of encapsulating drugs and providing sustained release, improved stability, and enhanced penetration across ocular barriers. When incorporated into gel systems, they further increase precorneal residence time, reduce drug drainage, and allow prolonged drug–cornea interaction. This dual delivery approach enhances bioavailability, minimizes dosing frequency, and improves patient compliance. Additionally, niosomal gels can be engineered using biocompatible polymers to achieve controlled and targeted drug delivery with minimal irritation. This review highlights recent advances in formulation strategies, preparation methods, characterization parameters, and in vitro and in vivo evaluation of niosomal gel systems for pilocarpine delivery. Furthermore, it discusses therapeutic advantages, limitations, and future perspectives, including the development of stimuli-responsive and targeted systems. Overall, niosomal gel-based delivery represents a promising approach for improving the efficacy and safety of glaucoma therapy. Such systems may also reduce systemic exposure, enhance ocular retention, and support sustained pharmacological action over extended periods, thereby offering a more reliable and patient-friendly therapeutic alternative for long-term glaucoma management and improved clinical outcomes overall.