The event-driven microscopy refers to a range of biological intravital microscopic imaging techniques that integrate optimized optical illumination, imaging, and sensing systems, along with advanced image processing algorithm and real-time feedback mechanisms. This approach enables the real-time monitoring and recording of dynamic activities while also facilitating the identification of specific events for optimizing imaging parameters or switching between different imaging modes. Consequently, it enhances both the resolution of imaging and system efficiency. Compared to conventional microscopes, the utilization of event-driven microscopes not only minimizes photo damage to biological samples, facilitating long-term stable observation of living activities, but also offers a distinct advantage in large-scale data processing. As a result, this technology has gained widespread application in the research of biological processes at the cellular and subcellular scales. This review provides an overview of the development history and classifications pertaining to event-driven intravital microscopy. Furthermore, we explore their wide-ranging applications in the investigation of neuroscience, cancer metastasis, and nanomedicine. Subsequently, we discuss limitations within this technology domain, and anticipate immense potential for event-driven microscopy in elucidating intricate biological dynamics and fostering advancements in precision medicine.