Acrophobia, or fear of heights, is a common and impairing specific phobia. Virtual reality exposure therapy (VRET) offers controlled, immersive height simulations that may overcome practical and acceptability barriers of in vivo exposure. This review synthesizes randomized controlled trials, controlled comparative studies, pilot studies, case reports, and meta-analyses evaluating VRET for acrophobia. Across these studies, VRET reliably reduces height-related anxiety, behavioral avoidance, and catastrophic cognitions, with effects that are large relative to no-treatment or waitlist controls. In head-to-head comparisons, outcomes for VRET are generally comparable to traditional in vivo exposure, with no significant differences observed on standard acrophobia outcome measures (e.g., Acrophobia Questionnaire, Attitude Towards Heights Questionnaire, Behavioral Avoidance Test). Adverse effects are uncommon and typically mild. Short-term follow-ups suggest maintenance of gains after treatment. Taken together, the evidence indicates that VRET is an effective, acceptable, and scalable option for acrophobia, suitable for clinical settings where real-world height exposures are difficult to deliver. Future work should clarify the durability of benefits over longer intervals and identify patient and treatment factors (e.g., sense of presence, guidance format) that optimize outcomes.