Background: Idiopathic intracranial hypertension (IIH) is a disorder of elevated intracranial pressure of unknown cause. It is characterized by increased intracranial pressure with its attendant signs and symptoms in an alert and oriented patient, but without localizing neurologic findings. Objectives: To evaluate management outcome of idiopathic intracranial hypertension (IIH) by depending on visual field changes as an indication for surgery. Patients & Methods: The study included twenty three IIH patients fulfilling Dandy criteria with free MRI brain. All patients underwent lumber puncture (LP) with measurement of CSF opening pressure and analysis of the released volume CSF. All patients underwent complete ophthalmological assessment, and decision making was based on the results of visual field examination. Results: Seven patients presented with insignificant visual field changes passed smooth follow-up for 9-18 months without deterioration of visual field or recurrence of symptoms after the initial LP and the maintained medical treatment. Four patients presented with marked visual field affection and lumbo-peritoneal shunt (LPS) was inserted urgently. Twelve patients presented initially with mild visual field changes developed deterioration of visual field on follow-up visits and underwent LPS. Conclusion: Visual field testing is a reliable indication for surgery in patients with IIH as visual acuity and color perception are generally affected late in papilledema..