To analyze crystalline lens decentration and tilt in eyes with different axial lengths (ALs) using a swept-source anterior segment optical coherence tomography (SS-AS-OCT).Patients with normal right eyes who visited our hospital between December 2020 and January 2021 were included in this cross-sectional study. Data on crystalline lens decentration and tilt, AL, aqueous depth (AD), central corneal thickness (CCT), lens thickness (LT), lens vault (LV), anterior chamber width (ACW), and angle κ were collected.A total of 252 patients were included and divided into normal (n = 82), medium-long (n = 89), and long (n = 81) AL groups. The average age of these patients was 43.63 ± 17.02 years. The crystalline lens decentration (0.16 ± 0.08, 0.16 ± 0.09, and 0.20 ± 0.09 mm, P = 0.009) and tilt (4.58° ± 1.42°, 4.06° ± 1.32°, and 2.84° ± 1.19°, P < 0.001) were significantly different among the normal, medium, and long AL groups. Crystalline lens decentration was correlated with AL (r = 0.466, P = 0.004), AD (r = 0.358, P = 0.006), ACW (r = -0.004, P = 0.020), LT (r = -0.141, P = 0.013), and LV (r = -0.371, P = 0.003). Crystalline lens tilt was correlated with age (r = 0.312, P < 0.001), AL (r = -0.592, P < 0.001), AD (r = -0.436, P < 0.001), ACW (r = -0.018, P = 0.004), LT (r = 0.216, P = 0.001), and LV (r = 0.311, P = 0.003).Crystalline lens decentration was positively correlated with AL, and tilt was negatively correlated with AL.