Optical fibre-based sensors measuring refractive index shift in bodily fluids and tissues are versatile and accurate probes of physiological processes. Here, we suggest a refractive index sensor based on a microstructured exposed-core fibre (ECF). By considering a high refractive index coating of the exposed core, our modelling demonstrates the splitting of the guided mode into a surface sensing mode and a mode that is isolated from the surface. With the isolated mode acting as a reference arm, this two-mode one-fibre solution provides for robust interferometric sensing with a sensitivity of up to 60, 000 rad/RIU-cm, which is suitable for sensing subtle physiological processes within hard-to-reach places inside living organisms, such as the spinal cord, ovarian tract and blood vessels. © 20192. Two-mode microstructured exposed core fibreWe consider a standard ECF structure [19] (Fig. 1) that consists of a Y-shaped silica core (the refractive index n co = 1.4607, 2.2 µm size) formed by three elliptical air holes (n air = 1)