Orbital inflammatory disease in a patient treated with zoledronate

To increase awareness of orbital inflammatory disease as a rare adverse effect of bisphosphonates.

We present a case report and a review of the relevant literature.

A 57-year-old woman with history of esophageal, breast, and lung cancers was diagnosed with postmenopausal osteoporosis. She initially received intravenous ibandronate for a total of 6 infusions. Later, she was changed to zoledronate infusion because of its yearly dosing schedule. Several hours after her initial infusion of zoledronate, she developed a painfully swollen left eye with photophobia. Ophthalmologic exam showed edema of the left upper lid. No exophthalmos was noted. Slit-lamp exam showed conjunctival injection in the left eye with an elevated intraocular pressure. An orbital computed tomographic scan showed inflammation of the left orbital, preseptal, and retroseptal spaces. She was started on 2 methylprednisolone dose packs and the swelling and erythema disappeared completely in 2 weeks. Subsequent orbital magnetic resonance imaging showed no mass within either the left or right orbit, and no abnormal enhancement following contrast administration.

Physicians should be aware of this rare complication of zoledronate. It should be used with caution in patients with a history of inflammatory eye disease or mild ocular symptoms following use of a bisphosphonate.