DOI: 10.12890/2026_005784

Zoledronic acid-induced orbital inflammation: a diagnostic challenge

Authors

  • Tala Nasrini Department of Internal Medicine, Koç University School of Medicine, Istanbul, Turkey 0009-0004-2085-8095
  • Adam Bacon Department of Internal Medicine, Mayo Clinic Arizona, Scottsdale, USA
  • Umesh Sharma Department of Internal Medicine, Mayo Clinic Arizona, Scottsdale, USA

talanasrini@gmail.com

Keywords

Zoledronic acid, orbital inflammation, preseptal cellulitis, bisphosphonate adverse effects

Abstract

Introduction: Zoledronic acid is a bisphosphonate widely used for osteoporosis and other bone disorders. In rare cases, it can cause ocular inflammation mimicking orbital cellulitis.
Case description: A 52-year-old woman developed right eye pain and swelling within 24 hours of her first zoledronic acid infusion. Examination revealed conjunctival redness and mild eyelid swelling without proptosis, ophthalmoplegia, or vision loss. Laboratory markers were largely normal. Computed tomography scan and magnetic resonance imaging showed preseptal and postseptal inflammation without abscess formation. Treatment with corticosteroids and antibiotics resulted in complete symptom resolution within one week.
Conclusion: Zoledronic acid can induce rapid-onset orbital inflammation. Awareness of this rare adverse effect is essential to avoid misdiagnosis and ensure timely treatment.

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References

  1. Lewiecki DEM. Safety of long-term bisphosphonate therapy for the management of osteoporosis. Drugs 2011;71:791–814. doi: 10.2165/11585470-000000000-00000
  2. Fraunfelder FW, Fraunfelder FT. Adverse ocular drug reactions recently identified by the National Registry of Drug-Induced Ocular Side Effects. Ophthalmology 2004;111:1275–1279. doi: 10.1016/j.ophtha.2003.12.052
  3. Sharma NS, Ooi J-L, Masselos K, Hooper MJ, Francis IC. Zoledronic acid infusion and orbital inflammatory disease. N Engl J Med 2008;359:1410–1411. doi: 10.1056/NEJMc0803366
  4. Peterson JD, Bedrossian EH. Bisphosphonate-associated orbital inflammation—a case report and review. Orbit 2012;31:119–123. doi: 10.3109/01676830.2011.648818
  5. Ryan PJ, Sampath R. Idiopathic orbital inflammation following intravenous pamidronate. Rheumatology 2001;40:956–7. doi: 10.1093/rheumatology/40.8.956
  6. Erickson BP, Lee WW. Orbital Cellulitis and Subperiosteal Abscess: A 5-year Outcomes Analysis. Orbit 2015;34:115-120. doi: 10.3109/01676830.2014.950286
  7. Benderson D, Karakunnel J, Kathuria S, Badros A. Scleritis complicating zoledronic acid infusion. Clin Lymphoma Myeloma 2006;7:145–147. doi: 10.3816/CLM.2006.n.053
  8. Faryal, Rehman, Amjad Hayat. Keeping an eye on bisphosphonate therapy in myeloma: a case report of ocular inflammation post-zoledronic acid infusion. Case Rep Hematol 2021;2021:6647277. doi: 10.1155/2021/664727
  9. Banal F, Briot K, Ayoub G, Dougados M, Roux C. Unilateral anterior uveitis complicating zoledronic acid therapy in prostate cancer. J Rheumatol 2008;35:2458–2459. doi: 10.3899/jrheum.080273
  10. Durnian JM, Olujohungbe A, Kyle G. Bilateral acute uveitis and conjunctivitis after zoledronic acid therapy. Eye (Lond). 2005;19:221–222. doi: 10.1038/sj.eye.6701461

Published

2026-03-05

Issue

Vol. 13 No. 4 (2026)

Categories

How to Cite

1.
Nasrini T, Bacon A, Sharma U. Zoledronic acid-induced orbital inflammation: a diagnostic challenge. EJCRIM [Internet]. 2026 Mar. 5 [cited 2026 Nov. 3];13(4). Available from: https://ejcrim.com/index.php/ejcrim/article/view/5784