Introduction: The aim of the study was to evaluate the refractive status and ocular biometric parameters in subjects with angle closure in Malaysia. Methods: This cross-sectional study was conducted on 171 primary angle closure patients (268 eyes). Visual acuity, refraction, and ocular biometry (central anterior chamber depth [ACD], axial length [AL], and lens thickness) were recorded. Vitreous cavity length (VL) and relative lens position (RLP) were calculated. Results: A total of 92 Primary Angle Closure Suspect (PACS), 30 Primary Angle Closure (PAC), and 146 Primary Angle Closure Glaucoma (PACG) eyes were included. Chinese ethnicity formed the majority ( n = 197, 73.5%), followed by Malay ( n = 57, 21.3%) and Indian ( n = 14, 5.2%). There was a significant female preponderance with a female to male ratio of 1.85. Mean age was 65.7 ± 7.7 years. Mean spherical equivalent was +0.33 ± 1.29 D. Approximately half ( n = 137, 51%) of the eyes were hyperopic (spherical power ≥+0.5), with PACG having the highest percentage of hyperopia ( n = 69, 50.4%). Myopia and emmetropia were present in 48 (17.9) and 83 (31%) eyes, respectively. Although AL and VL in myopia patients were significantly longer than emmetropic and hyperopic eyes ( p < 0.001), the ACD was not significantly different ( p = 0.427). While the RLP is smaller in myopic eyes, lens thickness was increased in hyperopic eyes. PACG was significantly higher in elderly patients compared to PACS and PAC ( p = 0.005). A total of 37 (13.8%) eyes were blind (vision worse than 3/60) and 19 of them (51.3%) were female patients. Conclusion: A decrease in RLP is predictive of angle closure disease in myopic eyes, whereas increased lens thickness contributes to angle closure disease in hyperopic eyes.