Microscope-integrated intraoperative OCT (iOCT) enables imaging of tissue cross-sections concurrent with ophthalmic surgical maneuvers. However, limited acquisition rates and complex three-dimensional visualization methods preclude real-time surgical guidance using iOCT. We present an automated stereo vision surgical instrument tracking system integrated with a prototype iOCT system. We demonstrate, for the first time, automatically tracked video-rate cross-sectional iOCT imaging of instrument-tissue interactions during ophthalmic surgical maneuvers. The iOCT scan-field is automatically centered on the surgical instrument tip, ensuring continuous visualization of instrument positions relative to the underlying tissue over a 2500 mm(2) field with sub-millimeter positional resolution and <1° angular resolution. Automated instrument tracking has the added advantage of providing feedback on surgical dynamics during precision tissue manipulations because it makes it possible to use only two cross-sectional iOCT images, aligned parallel and perpendicular to the surgical instrument, which also reduces both system complexity and data throughput requirements. Our current implementation is suitable for anterior segment surgery. Further system modifications are proposed for applications in posterior segment surgery. Finally, the instrument tracking system described is modular and system agnostic, making it compatible with different commercial and research OCT and surgical microscopy systems and surgical instrumentations. These advances address critical barriers to the development of iOCT-guided surgical maneuvers and may also be translatable to applications in microsurgery outside of ophthalmology.