Imaging of biofilm systems is a prerequisite for a better understanding of both structure and its function. The review aims to critically discuss the use of optical coherence tomography (OCT) for the visualization of the biofilm structure as well as its dynamic behavior. A short overview on common and well-known, established imaging techniques for biofilms such as scanning electron microscopy (SEM), confocal laser scanning microscopy (CLSM), Raman microscopy (RM), and magnetic resonance imaging (MRI) paves the way to imaging biofilms at the mesoscale, which is perfectly covered by means of OCT. Principle, resolution, imaging velocity, and limitations of OCT are subsequently presented and discussed in the context of biofilm applications. Examples are provided showing the strength of this technique with respect to the visualization of the mesoscopic biofilm structure as well as the estimation of flow profiles and shear rates. Common and new structural parameters derived from OCT datasets are presented. Additionally, the review shows the importance of OCT with respect to a better description of mechanical biofilm properties. Finally, the implementation of multi-dimensional OCT datasets in biofilm modelling is shown by several examples aiming on an improved understanding of mass transfer at the bulk-biofilm interface. Biotechnol. Bioeng. 2017;114: 1386-1402. (c) 2017 Wiley Periodicals, Inc.