Orbital Pseudotumor in a Patient Treated With Zoledronic Acid: A Case Report and Pertinent Literature Review

Abstract

Objective: To enhance recognition of ocular inflammation as a rare side effect of zoledronic acid. Methods: A case report of bisphosphonate-induced orbital inflammation with permanent visual deterioration and pertinent literature review. Results: A 66-year-old man with newly diagnosed osteoporosis and concomitant hypertension, hyperlipidemia, and gastroesophageal reflux disease was treated with intravenous zoledronic acid. He developed acute anterior uveitis on day 4 after treatment, manifested by orbital erythema, swelling, and decreased visual acuity. His symptoms resolved after a course of systemic glucocorticoid. However, he developed blurred vision 3 months after treatment with zoledronic acid and was diagnosed with cystoid macular edema and wrinkling retinopathy, thought to be related to prior history of uveitis. He underwent intravitreal steroid injection, with a partial response 6 months after use of zoledronic acid, later followed by retinal surgery. At 24 months after zoledronic acid infusion, he did not recover completely from the retinal surgery and his vision did not return to baseline. Conclusion: Physicians, including primary care doctors, endocrinologists, and ophthalmologists, should be aware of ocular inflammation as a potential complication of zoledronic acid. Prompt recognition and early initiation of treatment at the onset of symptoms can prevent long-term associated complications. Abbreviations: IV = intravenous