An Irritable Senior Manager With a New-Onset Lazy Eye

Heidi Moawad, MD


November 03, 2023

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.


A 55-year-old man visits his primary care physician for evaluation of a new-onset lazy eye that has been present for about 1 month. The patient has not noticed it; however, his colleagues at work have observed that occasionally one of his eyes does not seem to move in sync with the other, and that this is a new problem. He holds a senior position at work and was told by one of his peers that other coworkers have been afraid to mention the problem to him directly but are concerned about the potential health implications.

The patient says that his work has become stressful. He states that he is healthier than people who are much younger than he is and that "no one else over there knows what they are doing."

He takes medication for hypertension, which is well controlled. He was told that he has atrial fibrillation, and he has been taking aspirin daily. He also says that he has a peptic ulcer, and he occasionally uses over-the-counter medication for relief.

The patient has no history of smoking, drinking, or illicit drug use.


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