The purpose of this study was to study the aetiology, progression and outcome in patients with binocular diplopia presenting to the ophthalmology department of a tertiary care centre in India. The study had a prospective observational design where all patients presenting to the emergency or outpatient service over a period of one year were recruited. One hundred and sixty patients were included in the analysis, with a mean age of 40 (range 7-76) years. The most common cause for binocular diplopia was vasculopathy in 43 (28.7%) followed by trauma in 37 (24.7%). In patients under the age of 20 the most common cause was decompensating heterophoria, with these having the best prognosis. Traumatic cases were common in the age group 20-40 years and vascular in the >40 years age group. For all other causes, elderly patients had more resolution than young patients. Later recovery was associated with a number of factors including larger deviation, younger age and a history of trauma. The study provided insight into the patients who may require neuro-imaging and gives a broader picture into management options.