The authors present the findings of a retrospective observational chart review across three neuro-ophthalmology clinics. Databases at each clinic were searched using inclusion criteria based on established diagnostic criteria for idiopathic intracranial hypertension (IIH). Cases with missing data, atypical findings and less than one-year follow-up were excluded. A total of 156 patients were included in the analysis. None of the patients included in this analysis, all of whom had typical signs and symptoms, had their diagnosis or management changed by lumbar puncture (LP) or cerebral spinal fluid (CSF) analysis. The authors therefore question the practice of doing LPs on patients presenting with typical diagnostic criteria, when weighing up against the risks of the procedure. They believe experienced neuro-ophthalmologists (and they define what they mean by this) should have confidence in their diagnosis and use imaging to exclude alternative aetiologies. It is clear that further multicentre prospective studies are required to assess the balance of risk and benefit of LPs for the purpose of diagnosis and management planning for IIH.