The increasing popularity of marine wildlife tourism (MWT) worldwide calls for assessment of its conservation outcomes and the development of appropriate management frameworks to ensure the conservation of the species and habitats involved as well as the long-term sustainability of this industry. While many studies have examined the positive and/or negative implications of particular forms of MWT, few have attempted to identify factors of concern shared across different types of marine tourism, or examine their implications for sustainability in a broader perspective. We reviewed the existing literature to highlight common impacts on animal behaviour, health and ecology, and to identify successful cases based on minimal negative affects and/or lack of chronic/ irreversible impacts on target species or habitats. To ensure the achievement of both economic and ecologic objectives, the following steps should be integrated in MWT management: 1) Increase of research on the biology and ecology of target species/habitat and application of relevant information for the development of suitable policies, frameworks and management strategies; 2) Structured enforcement of existing policies and enhancement of ecological awareness of visitors through active education; 3) Application of an adaptive management framework to continuously improve the codes of conduct employed; 4) Involvement of different stakeholders and local communities in the development and improvement of the MWT activity. Combining these strategies with the extrapolation of frameworks and policies from cases where adverse ecological impacts have been addressed and successfully resolved can further contribute in ensuring the long-term health and conservation of the species/ habitats involved in MWT activities.