Introduction: The development of the surgical microscope has led to significant advances in the operative proficiency of varying surgical specialties including ENT surgery, ophthalmic surgery, general surgery, vascular surgery, neurosurgery and plastic surgery. Purpose: This article aims to review the history of the surgical microscope, and explore the collaborative roles between surgeons and scientists in developing equipment to push surgical procedure into the future. Discussion: The modern day computer-assisted surgical microscope is a cumulation of constant progress in optical engineering since the 19th century. Prior to this, surgeons improvised by mounting singe lens magnifiers onto spectacles or headbands to improve fine vision. A Swedish Otologits, Carl Olof Nylen, is credited with using the first surgical microscope in 1921 for better visualisation of a labyrinthine fistula in a case of chronic otits media. Yet this monocular system was surpassed later that same year when a Zeiss binocular surgical microscope was used for a similar case in Germany. Carl Zeiss alongside physicist Ernst Abbe, had revolutionised lens manufacturing in the late 19th century and introduced the concept of stereo visualization leading to the development of the binocular microscope. This system later incorporated the application of a light source, to improve depth perception and image brightness. Further refinements including continuously adjustable magnification and wide-angle optics continue to improve surgeon’s field of view, with the 21st century now seeing the advent of 3D technologies.