Microplastics (MPs) have become a critical pollutant, accumulating in aquatic ecosystems and posing significant environmental and human health risks. Approximately 5.25 trillion plastic particles float in global oceans, releasing up to 23,600 metric tonnes of dissolved organic carbon annually, which disrupts microbial dynamics. MPs arise from the breakdown of larger plastics, degraded by photodegradation, thermal degradation, and biological processes, which are influenced by polymer type and environmental factors. As carriers, MPs absorb and transport contaminants such as heavy metals, per- and polyfluoroalkyl substances (PFAS), and persistent organic pollutants (POPs) across trophic levels, thereby increasing toxicity within food webs. Key aquatic organisms, including microalgae, molluscs, and fish, experience cellular toxicity, oxidative stress, and disruptions in essential functions due to MP ingestion or adhesion, raising concerns about their bioaccumulation in humans through ingestion, inhalation, and dermal contact. The complex surface chemistry of MPs enhances their pollutant adsorption, a process modulated by environmental pH, salinity, and contamination levels, while aging and structural attributes further impact their bioavailability and toxicity. This review consolidates knowledge on MPs' occurrence, transformation, pollutant interactions, and methodologies for sampling and analysis, emphasizing advancements in spectroscopy and imaging techniques to improve MP detection in aquatic environments. These insights underscore the pressing need for standardized analytical protocols and comprehensive toxicological research to fully understand MPs' effects on ecosystems and human health, informing future mitigation strategies and policy development.