Purpose To assess topographic findings, anterior segment parameters and high-order aberrations (HOAs) by using corneal tomography in children with 2 diopters (dp) or more astigmatism. Methods Children with 2 dp or more astigmatism (study group) and children with astigmatism less than 1 dp (control group) were recruited. Corneal astigmatism, mean, steep, flat keratometry (K) findings, anterior and posterior K results and anterior segment parameters including anterior chamber depth, kappa distance, horizontal corneal diameter, mean, central, middle, peripheral corneal thicknesses (CT), white-to-white (WTW) distance and pupil diameter were measured by Galilei G4 Dual Scheimpflug corneal tomography. HOAs were also assessed and compared between groups. Results Fifty-eight eyes of 37 children in the study group and 37 eyes of 37 children in the control group were enrolled. The mean ages of groups were 9.7 +/- 2.4 years and 9.3 +/- 1.6 years in study and control groups, respectively. The mean astigmatism was 3.3 +/- 1.1 dp and 0.5 +/- 0.3 dp in study and control groups, respectively (p < 0.05). Total corneal astigmatism was 3.3 +/- 0.84 dp and 1.14 +/- 0.47 dp in study and control groups, respectively (p < 0.05). There was a significant difference between groups in terms of posterior steep K and posterior astigmatism values. Among anterior segment parameters, mean CT and WTW values were statistically different between groups. HOAs were found to be statistically different between groups. Conclusion Higher posterior corneal astigmatism, thinner mean CT and lower WTW distance were found in children with 2 dp or more astigmatism. Besides, HOAs were much more in these astigmatic children.