Background This study investigated the characteristics of corneal higher-order aberrations (HOAs) of the anterior surface, posterior surface, and total cornea in adolescents with mild to moderate myopia. Methods A total of 183 patients with myopia (183 eyes) aged 8 to 18 years were enrolled in this study. The axial length (AL) of the eyes was measured by an IOL-Master, and corneal curvatures (K-values) and HOAs were measured by a Pentacam anterior segment diagnostic analyzer. Results Results of this study showed that the anterior, posterior and total corneal horizontal coma Z(3)(1) were - 0.1249 +/- 0.105 mu m, 0.0009 +/- 0.001 mu m, and - 0.1331 +/- 0.116 mu m, respectively; the anterior, posterior and total corneal vertical coma Z(3)(- 1) were - 0.0212 +/- 0.164 mu m, 0.0003 +/- 0.043 mu m, and - 0.0216 +/- 0.168 mu m, respectively; and spherical aberration (SA) Z(4)(0) values were 0.2244 +/- 0.091 mu m, 0.1437 +/- 0.029 um, and 0.1889 +/- 0.090 mu m, respectively. Total corneal Z(3)(1) was statistically correlated with posterior corneal astigmatism (K(2)b - K(1)b) (p = 0.038). Total corneal Z(3)(- 1) was correlated with anterior corneal astigmatism (K(2)f - K(1)f) (p = 0.027). Anterior, posterior, and total corneal Z(4)(0) were correlated with anterior and posterior corneal curvature (K(1)f, K(2)f, K(1)b, K(2)b) (p = 0.001). Posterior corneal Z(4)(0)b was also significantly correlated with AL. Conclusions In adolescents with mild to moderate myopia, the posterior corneal surface shape may play a compensatory role in the balance of corneal aberrations, and the posterior corneal SA tended to become less negative as the AL increased. The corneal coma may also play a compensatory role in posterior corneal surface astigmatism, which was valuable for the treatment for improving visual quality. This conclusion still needs to be verified.