Ophthalmic Vein Thrombosis, Abducens Nerve Palsy, and Horner Syndrome Secondary to Lemierre Syndrome

Lemierre syndrome is a rare, life-threatening condition characterized by internal jugular vein thrombophlebitis and septic embolization. Ophthalmic complications are uncommon but clinically significant. This report describes a case of Lemierre syndrome presenting with ophthalmic vein thrombosis, abducens nerve palsy, and Horner syndrome. A 19-year-old man initially misdiagnosed with immune thrombocytopenic purpura developed neurological deficits, including aphasia and diplopia. Imaging revealed internal carotid artery dissection, cavernous sinus thrombosis, and superior ophthalmic vein occlusion. Ophthalmologic evaluation showed right ptosis, anisocoria, and an abduction deficit, consistent with Horner syndrome and abducens nerve palsy. Microbial cell-free DNA testing detected Fusobcaterium necrophorum , confirming Lemierre syndrome. Targeted antibiotic therapy and anticoagulation led to clinical stabilization, with mild residual ptosis at 6 months. This case highlights the importance of recognizing ophthalmic complications in Lemierre syndrome. Early diagnosis, targeted antimicrobial therapy, and a multidisciplinary approach are essential for optimal management.