<p>To investigate the association between recombinant human growth hormone (rhGH) therapy and ocular biometric and refractive characteristics in Korean children with idiopathic short stature (ISS). This cross-sectional study compared ocular parameters between children receiving rhGH therapy for ISS (GH group) and age- and sex-matched healthy controls. Comprehensive ophthalmologic assessments were performed, including axial length (AL), spherical equivalent refraction (SER), peripapillary retinal nerve fiber layer (pRNFL), and ganglion cell–inner plexiform layer (GC-IPL) thickness. The GH group showed significantly more myopic SER than controls (–1.68 ± 1.68 D vs. − 1.15 ± 1.17D, <i>p</i> = 0.048). Although mean AL was slightly longer in the GH group, the difference was not statistically significant (23.65 ± 1.10&#xa0;mm vs. 23.43 ± 0.98&#xa0;mm, <i>p</i> = 0.290). Sectoral pRNFL analysis revealed temporal thickening (<i>p</i> &lt; 0.001) in the GH group. In multivariable analyses within the GH group, longer treatment duration was significantly associated with more myopic SER (<i>P</i> = 0.009). Although treatment duration was also associated with longer AL in the primary model (<i>P</i> = 0.041), this association became attenuated after exclusion of age from the model (<i>P</i> = 0.249). Exploratory analyses additionally demonstrated significant associations between thinner GC-IPL thickness and both more myopic SER (<i>P</i> = 0.010) and longer AL (<i>P</i> = 0.029) in the GH group. RhGH therapy in children with ISS was associated with more myopic refraction and distinct ocular structural characteristics in this cross-sectional analysis. The association between longer rhGH treatment duration and more myopic SER may suggest a possible relationship between prolonged rhGH exposure and refractive status. These findings should be interpreted cautiously, and further longitudinal studies are needed to clarify the long-term relationship between rhGH exposure and ocular growth.</p>