Objective This study was designed to examine the feasibility of immersive virtual reality mirror therapy for upper limb paresis after stroke using a head-mounted display and provide preliminary evidence of efficacy. Design Ten outpatients with chronic stroke, upper limb hemiparesis, and a low predisposition for motion sickness completed a 12-session program of 30 mins each of immersive virtual reality mirror therapy. The virtual reality system provided the illusion of movement in the hemiparetic upper limb while suppressing the visual representation of the nonparetic side. Feasibility was assessed via patient compliance, adverse event tracking, the System Usability Scale, and the Simulator Sickness Questionnaire. Preliminary efficacy was evaluated using the Fugl-Meyer Upper Extremity and Action Research Arm Test. Results Immersive virtual reality mirror therapy for patients with chronic stroke was safe, well-tolerated, and without adverse events, such as simulator sickness. Motor outcomes revealed a small improvement for the Fugl-Meyer Upper Extremity from 21.7 (SD = 8.68) to 22.8 (SD = 9.19) that did not achieve statistical significance (P = 0.084). Conclusions Four weeks of immersive virtual reality mirror therapy was well-tolerated by chronic stroke patients. Our findings support further clinical trials of immersive virtual reality technologies and visually enhanced mirror therapies for stroke survivors.