The Mediterranean Sea is a semienclosed basin connected with the open sea mainly through the Strait of Gibraltar. Due to the circulation pattern and the long residence time ranging between 80 and 100 years, the Mediterranean Sea is a sensitive environment to eutrophication pressures. The main body of water of the Mediterranean is characterized by very low nutrient concentrations, and therefore, the Mediterranean is classified among the most oligotrophic (very poor waters in nutrients) seas of the world's oceans. However, some coastal areas, mainly in the northern part of the basin, receive excessive loads of nutrients from sewage effluents, river fluxes, aquaculture farms, fertilizers, and industrial facilities, showing intense eutrophic phenomena with many adverse effects for the marine ecosystem and humans. Various national and international authorities, in addition to monitoring, have taken legal and administrative measures to mitigate eutrophication trends in the area. The Mediterranean environment is a good paradigm of integration of extensive legal framework, scientific knowledge, and administrative practices. The Barcelona Convention, the Mediterranean Action Plan, and European Union Directives on water quality and coastal management, together with scientific information derived from international research programs in the Mediterranean, provide a sound background for practical actions in eutrophication problems. In the present work, the problem of coastal eutrophication in the Mediterranean is reviewed in connection with public policies of the Mediterranean States based on national and international legislation and scientific knowledge on Mediterranean oceanography-ecology and actions coordinated by international bodies. These common actions and practices on coastal management are also discussed in relation to the need for sustainable development and protection of the coastal zone in the Mediterranean Sea.