Fiber-optic based laser delivery systems are one of the most important applications of optical fibers in the medical industry. Silica optical fibers are becoming a standard vehicle for laser transport into the human body. Two types of silica core fibers with polymer cladding or glass cladding are being considered. Optical fiber coatings play an important role in fiber strength, reliability, and biocompatibility. Three major coatings, such as organic (polymeric), metallic, and inorganic, are commonly used on optical fibers. The polymeric coatings include ultraviolet-cured acrylate, silicone, and polyimide; metallic coatings include aluminum, indium, tin, and gold; inorganic coatings include oxides, carbides, nitrides, and carbon. In the medical industry, polymeric coatings are widely used. Metallic and inorganic coatings on optical fibers also can be considered. This paper highlights the strength, fatigue, and biocompatibility of silica fibers with different coatings.