title: Bisphosphonate-Induced Orbital Inflammation: A Case Series and Review.
abstract: BACKGROUND
  To present a series of patients with bisphosphonate induced orbital inflammation, and to review the clinical presentation, radiological features, treatment options and outcomes.
  
  
  METHODS
  We present a multicentre, retrospective case series review of patients with a clinico-radiological diagnosis of bisphosphonate induced orbital inflammation and review all the reported cases of this complication in the literature.
  
  
  RESULTS
  Four new patients with bisphosphonate induced orbital inflammation were added to the 25 cases in the literature. Intravenous zoledronate was the commonest precipitant (22/29, 75.9%) and inflammation occurred 1-28 (mean 3) days post-infusion. Orbital imaging identified orbital inflammation in 22/29 cases and extra-ocular muscle enlargement in 8/29. Five patients presented with reduced vision of which one - with anterior ischaemic optic neuropathy - did not resolve. The vision resolved in all except one patient, with most requiring steroid treatment.
  
  
  CONCLUSIONS
  Bisphosphonates have a pro-inflammatory effect, which can precipitate orbital inflammation. This rare, but potentially serious complication of bisphosphonate treatment should be considered by clinicians using bisphosphonate treatment and by ophthalmologists seeing patients with orbital inflammatory disease.
authors.affiliation: a South Australian Institute of Ophthalmology, Royal Adelaide Hospital , Adelaide , South Australia .|b School of Ophthalmology and Visual Sciences , University of Adelaide , Adelaide , South Australia .
authors.forename: Adnan
authors.initials: A
authors.lastname: Pirbhai
authors.affiliation: a South Australian Institute of Ophthalmology, Royal Adelaide Hospital , Adelaide , South Australia .|b School of Ophthalmology and Visual Sciences , University of Adelaide , Adelaide , South Australia .
authors.forename: Saul N
authors.initials: SN
authors.lastname: Rajak
authors.affiliation: a South Australian Institute of Ophthalmology, Royal Adelaide Hospital , Adelaide , South Australia .|b School of Ophthalmology and Visual Sciences , University of Adelaide , Adelaide , South Australia .
authors.forename: Lucy A
authors.initials: LA
authors.lastname: Goold
authors.affiliation: c Save Sight Institute, Sydney Eye Hospital , Sydney , NSW , Australia , and.
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Cunneen
authors.affiliation: c Save Sight Institute, Sydney Eye Hospital , Sydney , NSW , Australia , and.
authors.forename: Geoff
authors.initials: G
authors.lastname: Wilcsek
authors.affiliation: c Save Sight Institute, Sydney Eye Hospital , Sydney , NSW , Australia , and.
authors.forename: Peter
authors.initials: P
authors.lastname: Martin
authors.affiliation: d Division of Oculoplastic and Orbital Surgery , Department of Ophthalmology, Tel Aviv Medical Centre, Tel-Aviv University , Tel Aviv , Israel.
authors.forename: Igal
authors.initials: I
authors.lastname: Leibovitch
authors.affiliation: a South Australian Institute of Ophthalmology, Royal Adelaide Hospital , Adelaide , South Australia .|b School of Ophthalmology and Visual Sciences , University of Adelaide , Adelaide , South Australia .
authors.forename: Dinesh
authors.initials: D
authors.lastname: Selva
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019386:Alendronate / Q000009:adverse effects; D050071:Bone Density Conservation Agents / Q000009:adverse effects*; D001851:Bone Diseases, Metabolic / Q000188:drug therapy; D004164:Diphosphonates / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007093:Imidazoles / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D054517:Orbital Cellulitis / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000503:physiopathology; D055622:Orbital Myositis / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000503:physiopathology; D000077268:Pamidronate; D011859:Radiography; D012189:Retrospective Studies; D000077211:Zoledronic Acid
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D000077211:Zoledronic Acid; D000077268:Pamidronate; D019386:Alendronate
keywords: Bisphosphonate; complication; orbital inflammation; orbital inflammatory syndrome; side effect; zolendronate