Scleritis and other ocular side effects associated with pamidronate disodium.
OBJECTIVE
To evaluate reported cases of scleritis and other ocular side effects associated with pamidronate disodium, with emphasis on previously unreported cases of scleritis.


METHODS
Observational case series.


METHODS
Case reports from the National Registry of Drug-Induced Ocular Side Effects (Casey Eye Institute), the Food and Drug Administration, the World Health Organization, and the literature were reviewed to determine possible adverse ocular side effects associated with pamidronate disodium. The World Health Organization's Causality Assessment Guide was used to categorize an adverse drug reaction.


RESULTS
Seventeen cases of unilateral scleritis and one case of bilateral scleritis occurred, usually within 6 hours to 2 days after intravenous pamidronate disodium. Six patients had positive rechallenge testing with the scleritis occurring after a repeat drug exposure. Other ocular side effects with positive rechallenge data, associated with pamidronate disodium, include blurred vision, nonspecific conjunctivitis, ocular pain, bilateral anterior uveitis, and episcleritis.


CONCLUSIONS
This is the first report, with rechallenge data, of any drug causing scleritis. Pamidronate disodium can cause vision-threatening diseases, which may require discontinuing the drug in some uveitis cases and, in this series, all cases of scleritis.
Fraunfelder
Frederick W
FW
Casey Eye Institute, Oregon Health Sciences University, Portland, Oregon, USA. fraunfer@ohsu.edu
Fraunfelder
Frederick T
FT
Jensvold
Bree
B
D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects*; D003231:Conjunctivitis / Q000139:chemically induced*; D004164:Diphosphonates / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000139:chemically induced*; D000077268:Pamidronate; D015423:Scleritis / Q000139:chemically induced*; D014606:Uveitis, Anterior / Q000139:chemically induced*; D014786:Vision Disorders / Q000139:chemically induced*
D000970:Antineoplastic Agents; D004164:Diphosphonates; D000077268:Pamidronate