Ibandronic Acid Induced Orbital Inflammation and Concurrent Anterior Uveitis - A Rare Presentation

To report the first case of orbital inflammation with concurrent anterior uveitis induced by oral Ibandronate, a bisphosphonate used for osteoporosis and other bone disorders.

A 55-year-old female, with a history of diabetes and hypertension, developed bilateral eye pain, redness, and photophobia two days after taking oral Ibandronate for a thoracic spine fracture. Examination revealed reduced visual acuity, anterior uveitis at presentation, and bilateral proptosis two days later. The imaging revealed diffuse bilateral orbital inflammation.

After discontinuing the drug, the patient was treated with intravenous methylprednisolone, leading to significant improvement in ocular symptoms.

Bisphosphonates, including Ibandronate, can cause ocular adverse effects such as uveitis and orbital inflammation. The pathophysiology is linked to immune modulation via gamma T-cell activation. Most cases respond to discontinuation of drug and steroid administration. The risk-benefit ratio of steroid administration has to be weighed, as it can worsen osteoporosis. Early detection and timely discontinuation of the drug can avoid sight-threatening complications.

This case underscores the importance of early recognition and prompt management of ocular complications, particularly as the use of bisphosphonates continues to increase.