Sediment contamination in the Caribbean has not been extensively studied. This review article outlines known cases of sediment contamination in the Caribbean and their impacts on Caribbean ecosystems. It also discusses regulation and remediation of contaminated sediments in the Caribbean and speculates on what the future holds regarding sediment toxicity. Existing information suggests that sediment contamination may be widespread, although not severe in most areas. Puerto Rico and the U.S. Virgin Islands contain two National Priority List sites and one candidate site under U.S. Superfund jurisdiction. These territories will be more extensively studied under the U.S. Environmental Monitoring and Assessment Program. Regulation of sediment contamination is difficult within the Caribbean region because jurisdiction is shared by 27 independent countries and a number of territories and dependencies. In addition to establishing control of natural resources within a 200–mile offshore limit for each Caribbean nation, the recently created Exclusive Economic Zone contains provisions for environmental protection and management, but many governments in the region lack the resources to implement them. The Caribbean Action Plan formalizes international cooperation and assistance to overcome some of these limitations. Many Caribbean countries have experienced a strong industrial expansion and a rapid population growth during the last 30 to 40 years, and there is potential for further contamination as these islands develop.