Objective <p>To compare the diagnostic accuracy of anterior segment optical coherence tomography (AS-OCT) and in vivo confocal microscopy (IVCM) in evaluating Kayser–Fleischer (KF) rings in patients with Wilson disease (WD).</p> Methods and analysis <p>A prospective observational study enrolled 36 subjects (16 women) and 36 controls (16 women). All participants underwent both AS-OCT and IVCM, and the results were analyzed using McNemar’s test to assess diagnostic concordancet.</p> Results <p>KF rings were not detected either with AS-OCT or with IVCM in any of the controls. Among the WD patients, seven subjects who did not show KF rings on AS-OCT were found to have them on IVCM (<i>p</i> &lt; 0.05), six of whom were identified diagnosed with hepatic WD.</p> Conclusion <p>Both AS-OCT and IVCM can provide objective assessment of KF rings. IVCM offers better accuracy compared to AS-OCT, particularly for hepatic WD.</p>