Coastal fisheries are central to Pacific Island nutrition, livelihoods and cultural identity, yet growing microplastic contamination threatens food security and public health. This study integrates fishers’ knowledge of locally important coastal fish species with empirical measurements of microplastic loads to identify priority taxa for monitoring across Fiji, Tonga, Tuvalu and Vanuatu. Interviews with 110 fishers documented commonly caught species, and the number of times each taxon was reported was calculated. Family-level catch data and mean microplastic loads were each standardised between 0 and 1 to generate Catch and Microplastic Scores, which were multiplied to create an Exposure Index reflecting both social relevance and contamination levels. Regionally, Lethrinidae and Scombridae had the highest Exposure Index values, while Acanthuridae, Lutjanidae, Scaridae and Serranidae emerged as country-specific priorities. Gendered fishing patterns revealed differences in catch, influencing potential exposure pathways and highlighting the need for gender-disaggregated data in future assessments. This approach of combining local knowledge with contamination studies offers a replicable, regionally-grounded method for identifying key indicator species for future microplastic monitoring. Species within the Lethrinidae family, particularly Lethrinus harak, stand out as regional priorities because of their importance to subsistence and artisanal fisheries, exposure to microplastics and consistent occurrence across the region.