Saudi Arabia consists mainly of desert land. However, it has big and small natural wetlands and artificial wetlands. Most of these wetlands are seen along the Red Sea and the Arabian Gulf coastal regions. Al-Asfar Lake, located in the Eastern Region of Saudi Arabia, is one of the historical landmarks of Al-Ahsa province. The primary lake water source is agricultural drainage water, which some refer to as an artificial lake. This paper mainly aims to reflect shade on the wetlands in Saudi Arabia in general and to show in detail the environmental impacts of Al-Asfar Lake on the ecosystem and biodiversity of the study area. The analytical review of the previous studies conducted in Al-Asfar Lake was adopted in this article. Hence, the impact of the lake on the land-use system, water quality and biodiversity was illustrated as the main outputs of the review analysis. However, the sustainable management of Al-Asfar Lake requires the stakeholders to adopt the wetland ecosystem health concept, which might lead to improving the lake's environmental conditions.