Abstract
A 44-year-old female presented with central vision loss and photopsia in both eyes since 2 months. Multimodal imaging, field defects, electroretinogram abnormalities, and spectral domain optical coherence tomography changes were all suggestive of acute zonal occult outer retinopathy. En-face optical coherence tomography angiography (OCTA) images demonstrated hyper-reflective dots at the level of ellipsoid zone in both eyes in the presence of normal retinochoroidal vasculature. The patient was started on oral azathioprine and prednisolone. On two consecutive monthly follow-ups, en-face OCTA images demonstrated serial changes in the hyper-reflective dot morphology at ellipsoid zone level that have not been previously reported in the literature.