SAT-802 - Seeing the Unexpected: Ocular Inflammation after Zoledronic Acid Infusion

Abstract Body

Background:

Intravenous bisphosphonates, such as zoledronic acid, are the first line therapy for osteoporosis. Common adverse effects include acute phase reaction-like symptoms and arthralgias. Ocular inflammatory adverse events, such as episcleritis, have been rarely reported and remain under-recognized adverse effect, often posing diagnostic and management challenges.

Case summary:

A 64-year-old woman with osteoporosis and multiple pathological fractures who was initially treated with Teriparatide, but stopped after 3 months due to side effects, was given zoledronic acid infusion (4 mg over 15 minutes). Within four days of her first infusion, she developed acute unilateral eyelid swelling, erythema, and ocular pain. Ophthalmologic examination revealed diffuse episcleral injection with mild periorbital edema and no anterior chamber inflammation, consistent with episcleritis. Her pre-existing ocular conditions were stable and unchanged. She was treated with topical corticosteroids, a Medrol Dosepak, artificial tears, and cold compresses, resulting in symptomatic improvement.

Conclusion:

Although zoledronic acid is generally well tolerated, clinicians should maintain a high index of suspicion for acute ocular inflammatory reactions following infusion. Early recognition and prompt treatment are essential to mitigate symptoms. Increased awareness of this rare adverse effect may improve patient counseling and inform post-infusion monitoring strategies.

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