Mesophotic coral ecosystems (MCEs) were compared between La Parguera and Ponce, off the south coast of Puerto Rico. In contrast to La Parguera, Ponce has a narrow insular shelf and hosts several river outlets, a commercial port, a regional sewage treatment plant with associated deep water outfall, and three deep dredge disposal sites. Off Ponce, MCEs receive higher (16×) rates of sedimentation than off La Parguera, a less impacted site. The most impacted sites were located offshore of Cayo Ratones and are in or down-current and in close proximity to one of the dredge disposal sites. There, MCEs are characterized by a steep, irregular, rocky slope with a cover of fine-grained, dark brown sediment, which increases with depth. At shallower depths, scattered rocky outcroppings are colonized by sponges, black corals and algae. The sediment cover contains two to three times the terrigenous content and a significantly higher percentage of the fine-grained fraction than off La Parguera. Thirteen remotely operated vehicle (ROV) dives east and west of Ponce showed that the deepest depth at which corals were observed increased with distance from Cayo Ratones and did not approach depths observed off La Parguera except at the eastern-most (up-current) site, Caja de Muertos, which was also significantly further offshore. Benthic communities off Caja de Muertos were comparable to those at La Parguera, while off Cayo Ratones, there were no mesophotic corals and sparse development of other benthic macrobiota except sponges. Management authorities should include MCEs when assessing potential impacts from anthropogenic activities and take the necessary steps to reduce local threats.