Objectives: To review the patient characteristics, presenting symptoms, management plans, and long-term visual outcomes of Hong Kong Chinese patients with primary idiopathic intracranial hypertension (IIH). Methods: Case notes of Chinese patients diagnosed with primary IIH who attended one of three public ophthalmic centers in Hong Kong (Hong Kong Eye Hospital, Prince of Wales Hospital, and Alice Ho Miu Ling Nethersole Hospital) between January 2003 and December 2022 were retrospectively reviewed. The modified Dandy criteria were used to diagnose IIH. Data collected included patient characteristics, presenting symptoms, weight, body mass index (BMI), visual acuity (VA), automatic visual field (VF) indices, lumbar puncture opening pressure, treatment plans, and peripapillary retinal nerve fiber layer thickness. Results: In total, 32 eyes in 14 women and six men (mean age, 34.6 years) were included in the analysis. The mean BMI was 27.7 kg/m². Overall, 18 patients were symptomatic at presentation; 25 eyes had normal or near-normal VA (Snellen ≥20/30). All overweight patients received weight loss advice, whereas 18 patients were treated with oral acetazolamide, and eight of them required additional interventions, including medical therapy (n=3), cerebrospinal fluid shunting (n=3), repeated lumbar puncture (n=1), and venous sinus stenting (n=1). The mean follow-up duration was 9.0 years. At final follow-up, 26 eyes retained normal or near-normal VA, whereas eight eyes had mild VF loss, and one eye had peripapillary retinal nerve fiber layer thickness <90 microns. Conclusion: Primary IIH is uncommon in Hong Kong; most patients presented with mild visual impairment and achieved favorable long-term outcomes. Weight management and medical therapy remain the primary treatment. Lower BMI thresholds should be applied for Chinese patients. Referral for structured dietetic support may be beneficial.
