Purpose To determine the relationship between the triglyceride–glucose–body mass index (TyG-BMI) and the incidence of myopia in United States (US) adolescents. Methods In this cross-sectional study, we utilized data from the National Health and Nutrition Examination Survey, with a focus on adolescents aged 12–19 years. Multivariate logistic regression models were used to determine the relationship between TyG-BMI and myopia. Furthermore, a restricted cubic spline function logistic regression model was used to explore the linear relationship between changes in TyG-BMI and myopia. Lastly, stratified analyses and interaction term tests were performed. Results The incidence of myopia was noted to be 42.17% among US adolescents. TyG-BMI was significantly and linearly associated with myopia in adolescents (p < 0.05). Compared with adolescents in the low TyG-BMI group, those in the high TyG-BMI group exhibited a 20% higher risk of developing myopia (OR = 1.20, 95% CI: 1.0–1.5, p for trend < 0.05). Conclusions TyG-BMI is significantly and positively associated with myopia incidence in US adolescents. The higher incidence of myopia in the high TyG-BMI group suggests the importance of metabolic health for myopia development. Controlling metabolic health factors is essential for preventing myopia in adolescents.