Sustainable management of aquatic ecosystems requires effective strategies to monitor and mitigate microplastic pollution, particularly in vulnerable tidal river systems. Microplastic accumulation in these environments poses significant environmental risks, threatening biodiversity, ecosystem health, and long-term water quality. This study employs a three-dimensional hydrodynamic model (TELEMAC-3D—v8p5) coupled with a Lagrangian particle tracking model (CaMPSim-3D—v1.2.1) to simulate microplastic transport dynamics in the lower Fraser River, British Columbia, Canada. The model incorporates tidal forcing, riverine hydrodynamics, and mixing processes, and was validated with good agreement against observed water levels. This model provides a high-resolution representation of microplastic dispersion under varying release scenarios, including emissions from combined sewer overflows (CSOs) and wastewater treatment plants (WWTPs). A novel approach is proposed to identify microplastic accumulation zones using the OPTICS (Ordering Points to Identify the Clustering Structure) clustering algorithm. Accumulation zone locations remain spatially consistent despite variations in release volume. Persistent clusters occurred near channel constrictions and shoreline segments associated with flow deceleration. These findings demonstrate the robustness of the method and provide a systematic framework for prioritizing high-risk areas, supporting targeted monitoring and informing sustainable estuarine management.