Purpose

To present the diagnosis, differential diagnosis, and management of orbital inflammation following first-dose zoledronic acid infusion, and to raise awareness of bisphosphonate-related ocular adverse effects.

---

Methods

A 71-year-old woman with a history of breast carcinoma presented with right eye pain, redness, and swelling beginning 12 hours after first intravenous zoledronic acid infusion for osteoporosis. Initial treatment for a presumed allergic reaction was ineffective. Ophthalmic examination revealed normal visual acuity, severe pain with eye movements, eyelid edema, chemosis, and conjunctival hyperemia without fever or leukocytosis. Orbital CT suggested orbital cellulitis; however, MRI demonstrated retrobulbar inflammatory changes without abscess or mass. Infectious, metastatic, and traumatic causes were excluded. Due to concurrent urinary infection and patient reluctance, oral indomethacin was initiated instead of steroids, followed by oral prednisolone after partial response.

---

Results

Significant improvement in chemosis and hyperemia occurred within 3 days of NSAID therapy, but orbital pain persisted. After initiation of oral corticosteroids, all symptoms resolved by day 10. Steroid treatment was gradually tapered, and at 3-month follow-up, ophthalmologic examination was completely normal.

---

Conclusion

Bisphosphonate-associated orbital inflammation is rare but increasingly recognized. Clinical and radiologic overlap with orbital cellulitis may delay diagnosis. While mild ocular reactions may resolve spontaneously, severe cases typically require systemic corticosteroids. NSAIDs may provide partial benefit when steroids are contraindicated. Early recognition and appropriate treatment are essential to prevent complications, including vision loss.

---

Additional Authors

First name	Last name	Base Hospital / Institution
Nilay	Yuksel	University of Health Sciences, Ankara Bilkent City Hospital, Department of Ophthalmology, Ankara, Turkiye

↑ Back to top