Purpose: To examine the distribution and determinants of central corneal thickness (CCT) including birth weight and gestational age in a school-based samples of Grade 7 students in rural China. Methods: 2346 (93.5%) grade 7 students with a mean age of 13.8 years participated in the study. CCT was measured for both eyes using the LenStar LS900. Information regarding birth weight and gestational age was retrieved from the participants' delivery records. A linear regression model was established to examine the relationship of birth weight, gestational age and other factors with CCT. Results: The mean CCT in this population was 534.7 mu m and boys had a greater CCT compared with girls (P = .06). CCT was positively related to axial length (r = 0.056) while negatively related to anterior chamber depth (r = -0.076) and corneal power (r = -0.105) . In multivariate analyses, the cornea was 19.35 mu m thinner in individuals with low birth weight compared with those with normal. In addition, the cornea was 25.25 mu m thinner in prematurely born adolescents compared with full-term ones. The combined effect of birth weight and gestational age on CCT was not statistically significant (P for interaction = 0.12) Conclusions: Low birth weight and small gestational age are associated with thinner corneas in adolescence. This disparity across groups with different levels of birth parameters should be taken into account by future studies investigating CCT as risk factors or diagnostic tests for glaucoma.