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Delirium persists as the most common neuropsychiatric syndrome among medically ill hospitalized patients, yet its neural mechanisms remain poorly understood. The development of neuroimaging biomarkers has been difficult primarily due to the complexities of imaging patients experiencing delirium. Optical imaging techniques, including near-infrared spectroscopy (NIRS) and diffuse optical tomography (DOT), offer promising avenues for investigating delirium’s pathophysiology. These modalities uniquely stand out for delirium exploration due to their blend of spatiotemporal resolution, bedside applicability, cost-effectiveness, and potential for real-time monitoring. In this review, we examine the emergence of optical imaging modalities and their pioneering utility in delirium research. With further investment and research efforts, they will become instrumental in our understanding of delirium’s pathophysiology and the development of preventive, predictive, and therapeutic strategies.