Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, New York 13214-2016, USA.
Endocr Pract. 2011 Jul-Aug;17(4):e101-3. doi: 10.4158/EP11081.CR.
To increase awareness of orbital inflammatory disease as a rare adverse effect of bisphosphonates.
We present a case report and a review of the relevant literature.
A 57-year-old woman with history of esophageal, breast, and lung cancers was diagnosed with postmenopausal osteoporosis. She initially received intravenous ibandronate for a total of 6 infusions. Later, she was changed to zoledronate infusion because of its yearly dosing schedule. Several hours after her initial infusion of zoledronate, she developed a painfully swollen left eye with photophobia. Ophthalmologic exam showed edema of the left upper lid. No exophthalmos was noted. Slit-lamp exam showed conjunctival injection in the left eye with an elevated intraocular pressure. An orbital computed tomographic scan showed inflammation of the left orbital, preseptal, and retroseptal spaces. She was started on 2 methylprednisolone dose packs and the swelling and erythema disappeared completely in 2 weeks. Subsequent orbital magnetic resonance imaging showed no mass within either the left or right orbit, and no abnormal enhancement following contrast administration.
Physicians should be aware of this rare complication of zoledronate. It should be used with caution in patients with a history of inflammatory eye disease or mild ocular symptoms following use of a bisphosphonate.
提高对眼眶炎性疾病作为双膦酸盐罕见不良反应的认识。
我们报告 1 例病例并复习相关文献。
1 例 57 岁女性，患有食管、乳腺和肺癌，被诊断为绝经后骨质疏松症。她最初接受了总共 6 次静脉注射伊班膦酸盐治疗。后来，由于其每年的用药方案，她改用唑来膦酸注射液。在接受唑来膦酸首次输注后数小时，她出现左眼疼痛性肿胀伴畏光。眼科检查显示左眼上睑水肿。无眼球突出。裂隙灯检查显示左眼结膜充血，眼压升高。眼眶计算机断层扫描显示左侧眼眶、眶隔前和眶隔后间隙炎症。她开始使用 2 个甲泼尼龙剂量包，2 周内肿胀和红斑完全消失。随后的眼眶磁共振成像显示左右眼眶内均无肿块，且对比剂给药后无异常强化。
医生应意识到唑来膦酸这一罕见并发症。对于有炎症性眼病病史或使用双膦酸盐后出现轻度眼部症状的患者，应谨慎使用。
