A case report: zoledronic acid-induced anterior uveitis

Background Bisphosphonates prevent bone loss by binding on active sites of bone remodeling and inhibiting osteoclast-mediated bone resorption. Zoledronic acid is recommended for patients with bone metastases from breast, prostate, and lung cancers. Objective To report a case of anterior uveitis after the infusion of zoledronic acid. Case Summary A breast cancer patient with bone metastasis was admitted with pain, visual loss, hyperemia, and periorbital swelling in her right eye 24 h after the first dose of zoledronic acid. Biomicroscopic anterior segment examination of the right eye showed corneal keratic precipitates, ciliary injection, and moderate amount of cells in anterior chamber. With the diagnosis of right anterior uveitis, topical prednisolone acetate (1%) was started, and her symptoms completely resolved within 1 week. Use of the Naranjo probability scale indicated a probable relationship between uveitis and zoledronic acid therapy in our patient. Discussion Uveitis is a rare complication of zoledronic acid. The mechanism is unclear. Proinflammatory cytokines such as TNF-α and IL-6 may also play a role in pathogenesis of zoledronic acid-related uveitis. Conclusion Zoledronic acid may be associated with inflammatory eye diseases and result in serious ocular damage.