Metal ions play a crucial role in many biochemical processes, and when in a state of scarcity or surplus, they can lead to various diseases. Therefore, the development of a selective, sensitive, cost-effective, and fast-responding sensor to detect metal ions is critical for in vitro medical diagnostics. In recent years, fluorescent sensors have been extensively investigated as potent kits for the effective assessment of metal ions in living systems due to their high sensitivity, selectivity, ability to perform real-time, non-invasive monitoring, and versatility. This review is an overview of recent advances in fluorescent sensors for the detection and imaging of metal ions in biosystems from 2018 to date. Specifically, we discuss their application in detecting essential metal ions and non-essential metal ions for in vitro diagnostics, living cell imaging, and in vivo imaging. Finally, we summarize remaining challenges and offer a future outlook on the above topics.