In this report, three pediatric cases are presented with a sudden onset of binocular diplopia. A 10-year-old boy suffered from diplopia, ptosis and muscle weakness caused by a neuromuscular disease (Miller Fisher syndrome). The other two patients had infections: a 6-year-old girl presented with an apical petrositis with an abducens nerve paralysis following a middle ear infection (Gradenigo's syndrome). The third patient, a 10-year-old boy, suffered from a sinusitis with involvement of the third and the fourth cranial nerve. These three cases illustrate that a prompt diagnostic evaluation and treatment are necessary in children presenting with a sudden onset of diplopia.