Zoledronate-Associated Orbital Inflammation: A Case Series and Literature Review.

Authors

Madeline Arzbecker, Ryan D Larochelle, Cat N Burkat, Elaine M Downie, Jackson Korger, Mihai Mititelu, Suzanne W van Landingham

Published in

WMJ : official publication of the State Medical Society of Wisconsin. Volume 125. Issue 4. Pages 537-541.

Abstract

Bisphosphonates are known to cause acute systemic inflammation through stimulation of proinflammatory cytokines. This reaction can include conjunctivitis, anterior uveitis, episcleritis, scleritis, and, rarely, orbital inflammation. We present 2 cases of zoledronate-associated orbital inflammation and a literature review highlighting treatment challenges.
The first case was managed with intravenous (IV) methylprednisolone, 1 mg/kg, followed by a short steroid taper. Symptoms recurred after completion of the taper. The second case presented with optic perineuritis and preseptal and postseptal inflammation. Initial treatment with IV methylprednisolone, 1 mg/kg, resulted in incomplete response, necessitating escalation to high-dose corticosteroid therapy.
A literature review identified 19 additional cases of zoledronate-associated orbital inflammation. There was no clear consensus regarding treatment and only 1 reported case of relapse was identified.
We recommend initial treatment with IV methylprednisolone, 1 mg/kg, followed by a prolonged taper. If symptoms do not improve within the first day of treatment or if the optic nerve sheath is involved, escalation to IV methylprednisolone, 1 g daily, may be warranted.

PMID:
42981531
Bibliographic data and abstract were imported from PubMed on 05 Nov 2026.

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