Wastewater generated during tunnel construction and tunnel cleaning contains diverse pollutants that may pose significant environmental risks if discharged without proper treatment. This review systematically summarizes the sources, characteristics, characterization methods, and treatment technologies of tunnel-related wastewater from an engineering perspective. Tunnel construction wastewater typically exhibits high suspended solids (73–6250 mg/L), elevated pH values (up to 13), ammonia nitrogen, and metal ions, whereas tunnel wash wastewater is dominated by traffic-related organic micropollutants, including polycyclic aromatic hydrocarbons (≤ 4 μg/L), nonpolar oil (≤ 70 mg/L), and trace metals (1.2–27,000 μg/L). Conventional and advanced characterization techniques, ranging from routine physicochemical parameters to spectroscopic and chromatographic analyses, are critically reviewed with emphasis on their analytical capabilities, limitations, and practical applicability. Treatment technologies based on physical, chemical, biological, and membrane processes are systematically evaluated. Chemical coagulation–flocculation can achieve suspended solids removal efficiencies exceeding 90%, while integrated treatment systems combining coagulation, filtration, and membrane processes demonstrate superior performance, enabling more than 99% removal of salts and metals and meeting reuse standards under complex operating conditions. Unlike previous reviews that focus on individual technologies or specific pollutants, this review provides a critical, side-by-side comparison of tunnel wastewater characterization and treatment approaches, highlighting their engineering applicability, operational robustness, and inherent limitations under realistic construction scenarios. Key technical challenges and future research directions toward sustainable and adaptable tunnel wastewater management are also discussed.