Water quality-related incidents are attracting attention globally as they cause serious diseases and even threaten human lives. The current detection and monitoring methods are inadequate because of their long operation time, high cost, and complex process. In this context, there is an increasing demand for low-cost, multiparameter, real-time, and continuous-monitoring methods at a higher temporal and spatial resolution. Optofluidic water quality sensors have great potential to satisfy this requirement due to their distinctive features including high throughput, small footprint, and low power consumption. This paper reviews the current development of these sensors for heavy metal, organic, and microbial pollution monitoring, which will breed new research ideas and broaden their applications.