Zoledronic acid-induced orbital inflammation: a diagnostic challenge

Abstract

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.