ZnO nanoparticles (ZnO NPs) have gained more attention in recent years due to their ability to induce the generation of reactive oxygen species (ROS) under light irradiation. Photo-triggered ROS generation by ZnO NPs and the resulting phototoxicity in cells have found use in antibacterial and anticancer applications. This review highlights recent advances in the development of ZnO NPs and hybrid-type functionalized ZnO NPs for photo-triggered antibacterial and anticancer activities. In addition, various chemical modifications including metal doping, metal hybridization, modification with polymers, and sensitization by organic photosensitizers have been further introduced to enhance the photocatalytic efficiency and ROS generation capability of ZnO NPs. The enhanced ROS generation efficiency of modified ZnO NPs consequently increases their antibacterial and anticancer activities. Additionally, we offer some insights into the design and engineering of next-generation ZnO NPs for more effective antibacterial and anticancer applications.