Bilosomes are lipidic or surfactant-based nanovesicles with bile salts as key constituents and have emerged as promising carriers for diverse administration routes, including topical, oral, transdermal, and ophthalmic applications. In ocular drug delivery, bilosomes have provided some unique advantages over traditional nano-vesicular systems, which include improved permeation, prolonged retention, enhanced stability, and high deformability, resulting in better drug availability for therapeutic action. This review focuses on the quality attributes and process parameters that govern the design and functionality of bilosomes for ocular drug delivery. By addressing critical material attributes and certain formulation techniques, we provide insights into how these factors influence the stability, permeability, and therapeutic efficacy of bilosome-based systems. Advancements in bilosome formulations for treating ocular disorders, such as glaucoma, bacterial conjunctivitis, and keratitis, are highlighted. Additionally, the potential of surface-modified bilosomes with targeting moieties to enhance drug delivery characteristics is discussed. This review aims to provide a comprehensive overview of bilosome-based approaches, including decorated bilosomes, as a novel strategy for addressing challenges in ocular drug delivery.