Ultrasound sensors play an important role in biomedical imaging, industrial nondestructive inspection, etc. Traditional ultrasound sensors that use piezoelectric transducers face limitations in sensitivity and spatial resolution when miniaturized, with typical sizes at the millimeter to centimeter scale. To overcome these challenges, optical ultrasound sensors have emerged as a promising alternative, offering both high sensitivity and spatial resolution. In particular, ultrasound sensors utilizing high-quality factor (Q) optical microcavities have achieved unprecedented performance in terms of sensitivity and bandwidth, while also enabling mass production on silicon chips. In this review, we focus on recent advances in ultrasound sensing applications using three types of optical microcavities: Fabry-Perot cavities, π-phase-shifted Bragg gratings, and whispering gallery mode microcavities. We provide an overview of the ultrasound sensing mechanisms employed by these microcavities and discuss the key parameters for optimizing ultrasound sensors. Furthermore, we survey recent advances in ultrasound sensing using these microcavity-based approaches, highlighting their applications in diverse detection scenarios, such as photoacoustic imaging, ranging, and particle detection. The goal of this review is to provide a comprehensive understanding of the latest advances in ultrasound sensing with optical microcavities and their potential for future development in high-performance ultrasound imaging and sensing technologies.