The positional accuracy of satellite imagery is essential for remote sensing cameras. However, vibrations and temperature changes during launch and operation can alter the exterior orientation parameters of remote sensing cameras, significantly reducing image positional accuracy. To address this issue, this article proposes an exterior orientation parameter variation real-time monitoring system (EOPV-RTMS). This system employs lasers to establish a full-link active optical monitoring path, which is free from time and space constraints. By simultaneously receiving star and laser signals with the star tracker, the system monitors changes in the exterior orientation parameters of the remote sensing camera in real time. Based on the in-orbit calibration geometric model, a new theoretical model and process for the calibration of exterior orientation parameters are proposed, and the accuracy and effectiveness of the system design are verified by ground experiments. The results indicate that, under the condition of a centroid extraction error of 0.1 pixel for the star tracker, the EOPV-RTMS achieves a measurement accuracy of up to 0.6″(3σ) for a single image. Displacement variation experiments validate that the measurement error of the system deviates by at most 0.05″ from the theoretical calculation results. The proposed EOPV-RTMS provides a new design solution for improving in-orbit calibration technology and image positional accuracy.