Optical surface waves, owing to their label-free nature and high sensitivity, have found extensive applications in the biomedical field. Bloch surface waves (BSW), which do not require metallic media, exhibit superior characteristics such as low absorption loss and high detection sensitivity, making them highly promising for biomedical applications. This paper introduces the generation principles and excitation methods of BSW detection technology, covering technical features and research progress in prism coupling, grating coupling, optical fiber coupling, and waveguide coupling. It focuses on the current application status of BSW in two major domains: biomedical sensing and imaging. For sensing applications, the paper analyzes breakthrough advances in label-free detection, fluorescence-enhanced detection, and dual-mode detection. For imaging applications, it elaborates on their label-free high-resolution imaging capabilities as well as the key mechanism for achieving super-resolution imaging through integration with structured illumination microscopy. Finally, future development directions for BSW technology are envisioned, emphasizing sensitivity enhancement and multimodal integration.