Plastic pollution in freshwater ecosystems, including microplastics (MPs) smaller than 5 mm, has become an emerging global concern. Asia is considered a “hot spot” for plastic pollution due to rapid economic and demographic growth, together with rapid urbanization. Here, we provide an overview of the current knowledge on MP abundance, sources, fate, and transfer in Asian freshwater ecosystems based on publications from January 2014 to May 2021. MP contamination in freshwater compartments, including water, sediment, and biota, was found to vary strongly. In water, it ranged from 0.004 items m−3 in a moderately urbanized region to more than 500,000 items m−3 in a dumping river in a highly populated watershed. In the sediment, MP abundance ranged from 1 to more than 30,000 items kg−1 dry weight. Polyethylene (PE) and polypropylene (PP) were predominant in both water and sediment compartments. MP was detected in biota samples from all the studied species, but their abundance depended on the locations and species studied. Overall, MP characteristics (form, size, color, and polymer type) depended on sources and natural constraints (mainly hydrodynamics). This study also revealed that MP in Asian freshwater ecosystems mainly originated from domestic wastewater/runoff, followed by industrial emissions, fisheries and aquaculture wastewater. Plastic waste is not efficiently recycled or incinerated in Asia, leading to MP transfer and accumulation in the aquatic environment, and, more importantly, to ingestion by low to high trophic level organisms. This work highlights several knowledge gaps to guides future research to improve MP pollution management for the sustainable development of highly populated regions such as Asia.