Severe hypertriglyceridemia can give rise to a fundus appearance with whitish-colored retinal vessels called lipemia retinalis. A 52-year-old man with hypertriglyceridemia presented with a best-corrected visual acuity of 20/20 in both eyes and creamy-white retinal vessels on fundus. Spectral-domain optical coherence tomography (SD-OCT) revealed hyperreflective and engorged retinal vessels and white dots mainly accumulated in the inner nuclear and ganglion cell layer. Follow-up fundus examination after plasmapheresis sessions revealed normal retinal vessels. The hyperreflective appearance of the retinal vessels in OCT reversed rapidly 5 days after the treatment, whereas hyperreflective dots in retina disappeared slowly in 3 months. OCT is useful in demonstrating inner retinal changes associated with lipemia retinalis at histopathological level. The hyperreflective dots in inner retina associated with leakage from superficial retinal capillaries attested the correlation of their location with their origin.