Concerns, arguments, and approaches to sustainability are exposed in both scientific and technical irrigation literature which is based on the priority of food production and water preservation as a basic resource. Different approaches related to sustainable irrigated agriculture are identified beyond the technical considerations of irrigation as dealt with by very specialized scientific literature. These focus on socio-economic and institutional aspects of irrigation management. In this chapter, four main approaches are discussed: "New institutionalism" is an approach which emphasizes economic and financial issues such as cost recovery and the role of the market in water rights reallocation. A second approach, "Common pool resources management" highlights the role of local organizations and institutions with respect to collective water management, and the possibilities to design "robust institutions" considering the involvement of different stakeholders, not only (state) authorities. A third is identified as the "Empowerment approach". In this approach, topics such as power relations, autonomy, gender relations, as well as water rights and access are considered as key elements configuring water management practices in irrigation systems. Finally, there is the "Post-institutional approach". It outlines concepts such as "institutional bricolage", uncertainty, and legal pluralism used as analytical elements to understand the dynamics and complexities of irrigation development. In conclusion, different levels to analyze sustainability are discussed from an institutional perspective by identifying key knowledge gaps and the need to integrate some of the elements found in the different approaches.