Orbital inflammation and ischemic optic neuropathy secondary to zoledronate infusion: a Case Report
Author: Mohamed Omar MILADI
Base Hospital / Institution: Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, Monastir, Tunisia
ePoster presentation
Abstract ID: 24-287
Purpose
To report a case of orbital inflammation and ischemic optic neuropathy secondary to zoledronate infusion
Methods
Case report
Results
A 75-year-old woman developed right eye pain, redness, eyelid edema and chemosis beginning within 3 days after her first-ever intravenous infusion of 4 mg of zoledronate to treat osteoporosis. She was first diagnosed with orbital cellulitis and treated with oral antibiotics. Two days later, she was referred to our department for worsening of symptoms. On examination, visual acuity of the right eye was limited to hand movement with alteration of the afferent pupillary reflex, the anterior chamber and vitreous cavity were quiet, and the fundus examination showed optic disc edema. Examination of the left eye was unremarkable.
An exhaustive work-up including infectious, systemic, and immunological causes of orbital inflammation was performed. Results were either normal or negative. A final diagnosis of orbital inflammation and ischemic optic neuropathy secondary to zoledronic infusion was made. The patient was treated with three doses of methylprednisolone 1 g intravenous followed by oral corticosteroid therapy. Antibiotics were discontinued. The evolution after 6 weeks was marked by the regression of orbital inflammatory signs and the appearance of right optic nerve atrophy. Final acuity at 3 month-follow-up was hand movements.
Conclusion
Orbital inflammation associated with ischemic optic neuropathy are a rare but a serious side effect of zoledronate infusion. The mechanism is not well elucidated. The diagnosis is challenging. Visual prognosis is guarded despite prompt initiation of corticosteroids.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Sana | Khochtali | Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, Monastir, Tunisia |
| Mootaz | Mourali | Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, Monastir, Tunisia |
| Imen | Ksiaa | Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, Monastir, Tunisia |
| Nesrine | Abroug | Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, Monastir, Tunisia |
| Moncef | Khairallah | Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, Monastir, Tunisia |
