A quarter of the world’s population uses groundwater from karst aquifers. A range of emerging organic contaminants (EOCs) are considered a potential threat to water resources and dependant ecosystems, and karst aquifers are the most vulnerable groundwater systems to anthropogenic pollution. This paper provides the first global compilation (based on 50 studies) of EOCs in karst aquifers and explores EOC occurrence and the use of EOCs to understand karst systems. Of the 144 compounds detected in the reviewed studies, the vast majority in karst groundwater are pharmaceuticals and pesticides. Maximum concentrations of compounds varied over five orders of magnitude, and nearly half of the detected compounds exceed 100 ng/L. Karst groundwater is shown to have lower frequency of detection and lower concentrations compared to surface waters and local shallow intergranular aquifers, but overall higher concentrations compared to other major aquifer types. A growing number of studies have demonstrated the utility of EOCs and some legacy compounds for groundwater quality assessment and as tracers for characterising karst systems. They can improve understanding of vulnerability, storage, attenuation mechanisms, and in some cases have been used to assist with catchment delineation. This is a growing research area for karst hydrogeology, and more research is needed to understand EOC contamination of karst aquifers, and to develop EOCs as tracers within karst to improve our understanding of this critical water resource.