Waterlogging and secondary salinization are major drivers of land degradation in irrigated dryland regions, undermining soil productivity and long-term sustainability. Pakistan's Indus Basin Irrigation System (IBIS), one of the world's largest irrigation networks, supports national food security over approximately 16.7 million hectares (Mha). However, large-scale canal irrigation, combined with flat topography, monsoonal recharge, and inefficient water management, has disrupted groundwater balance, leading to persistent shallow water tables and widespread land degradation. Currently, nearly one-third of the irrigated area is affected by groundwater depths of less than 3 m. This review synthesizes six decades of waterlogging development and management in the IBIS, analyzing the evolution of drainage infrastructure, salinity control strategies, groundwater exploitation, and institutional reforms within a land sustainability perspective. Although large-scale interventions-including 61 Salinity Control and Reclamation Projects (SCARPs) and major outfall systems-initially reclaimed substantial areas, long-term performance has been constrained by governance fragmentation, inadequate operation and maintenance, and environmentally problematic effluent disposal. The Indus Basin experience underscores the need to move beyond infrastructure-centered solutions towards more integrated land-water governance and adaptive management to enhance land system resilience in irrigated regions facing growing climatic and resource pressures.