The authors present the results of a retrospective records review of 244 children presenting with diplopia over a three-year period. The majority of cases presented to paediatric ophthalmology clinic; other routes of presentation included eye casualty, neuro-ophthalmology or another eye clinic. Binocular diplopia was more common than monocular diplopia, intermittent frequency was more common than constant and horizontal was more common than vertical or a combination. Ocular misalignment was present in the majority of cases, more so at distance fixation than near. The clinical diagnosis starting with the most prevalent were as follows: non-paralytic strabismus, trauma and cranial nerve palsies. A significant difference found between the diagnostic groups was related to timing of presentation, those with tumour or neurological condition presented more acutely than both non-paralytic strabismus or cranial nerve palsies. The authors report the range of management strategies, with observation being a common management strategy and the prevalence of diplopia resolution in this population. This study provides the characteristics of a paediatric population presenting with diplopia, and provides an insight for future prospective research in this area.