Traditional tendon design methods for prestressed concrete (PC) continuous girder bridges are tedious since they obtain feasible solutions based on trial calculation, and the existing optimization methods that can obtain the optimal solution have deficiencies regarding structural stress. In this study, based on research on the refined bridge design conducted in the Department of Bridge Engineering at Tongji University in recent years, a stress index-based tendon optimization method for PC continuous girder bridges is pro-posed. First, various tendon layouts are summarized, and a reasonable tendon layout is selected. Then, a mathematical tendon optimization model is established. After meeting the specifications and construction feasibility requirements, a genetic algorithm is used to find the optimal solution. This method not only realizes tendon forward design but also obtains a satisfactory solution. Finally, this method is used to successfully optimize the tendons of a three-span PC continuous girder bridge, which verifies the ration-ality of the method.