Semiconducting single-walled carbon nanotubes (SWCNTs) fluoresce in the near-infrared range, which overlaps with the transparency window of biological samples, and they do not photobleach or blink. Moreover, they benefit from biocompatibility and the large surface area available for functionalization. Using tailored surface functionalization, SWCNTs can be rendered optical nanosensors, such that surface binding events or changes in the local proximity of the nanotubes translate to a modulation of the emitted fluorescence. This approach was successfully used to demonstrate the detection of small molecules, volatiles, bacteria, microRNA, proteins, metals, self-assembly processes, and active processes in vivo. We will discuss different strategies for monitoring enzymatic activity and inhibition using SWCNT-based sensors, including the incorporation of the enzyme’s target bond within a synthetic molecular complex used for suspending the SWCNTs, or by the detection of the product of the enzyme hydrolytic activity. We will also highlight recent applications of these techniques in clinically relevant samples. These findings not only showcase the potential of near-infrared fluorescent SWCNT in tracking enzymatic activity but also underscore their promising role in advancing biomedical research and applications.