Heavy metal pollution poses a serious threat to coastal ecosystems, particularly in rapidly urbanizing and industrializing areas. This review synthesizes research conducted between 2015 and 2024 on heavy metal contamination in the coastal waters and sediments of Mombasa, an economic hub along the western Indian Ocean. It focuses on key metals including lead (Pb), cadmium (Cd), mercury (Hg), copper (Cu), and zinc (Zn), examining their concentrations, spatial distribution, sources, and ecological risks. Elevated levels of these metals were recorded in regions affected by port operations, industrial effluents, sewage discharge, and urban run-off.  Tudor Creek, Port Reitz, Makupa, and Kilindini Harbour emerged as the hotspots of pollution. Sediments were found to serve as both sinks and secondary sources of contaminants. Bioaccumulation in marine organisms, such as mollusks and fish, raises concerns about food safety and marine biodiversity. While several localized studies have been conducted, there is a notable lack of long-term monitoring and standardized risk assessments. This review identifies critical knowledge gaps and highlights the need for integrated pollution control, stricter enforcement of environmental regulations, and increased community involvement to support sustainable management of Mombasa's coastal and marine environment.