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Electrochemiluminescence (ECL), an intriguing luminescent phenomenon induced by electrochemical stimulation, has evolved from studying electron transfer reactions to a powerful analytical method and imaging technique. ECL can be generated through annihilation or co-reactant methods, with recent advancements integrating it into imaging devices for diverse applications. This review traces the evolution of ECL from its early applications to recent developments in imaging technology. Notably, the utilization of charge-coupled devices (CCD) and electron multiplying charge-coupled devices (EMCCD) in ECL microscopy has revolutionized imaging capabilities, making it a cost-effective option for point-of-care testing. The review explores the heterogeneous ECL mechanism, emphasizing its limitations and challenges in visualizing objects away from the electrode surface. The synergy between ECL and microscopy is highlighted, showcasing its diverse applications and contributions to understanding ECL mechanisms and improving its use in biological contexts. Finally, the review encapsulates innovative approaches in material design, surface modification, and electrode architecture, providing a comprehensive overview of strategies to control the active layer of the ECL and advance ECL microscopy. [ABSTRACT FROM AUTHOR]