Ibandronic Acid Induced Orbital Inflammation and Concurrent Anterior Uveitis - A Rare Presentation.

Aim: To report the first case of orbital inflammation with concurrent anterior uveitis induced by oral Ibandronate, a bisphosphonate used for osteoporosis and other bone disorders.

Material and methods: A 55-year-old female, with a history of diabetes and hypertension, developed bilateral eye pain, redness, and photophobia two days after taking oral Ibandronate for a thoracic spine fracture. Examination revealed reduced visual acuity, anterior uveitis at presentation, and bilateral proptosis two days later. The imaging revealed diffuse bilateral orbital inflammation.

Results: After discontinuing the drug, the patient was treated with intravenous methylprednisolone, leading to significant improvement in ocular symptoms.

Discussion: Bisphosphonates, including Ibandronate, can cause ocular adverse effects such as uveitis and orbital inflammation. The pathophysiology is linked to immune modulation via gamma T-cell activation. Most cases respond to discontinuation of drug and steroid administration. The risk-benefit ratio of steroid administration has to be weighed, as it can worsen osteoporosis. Early detection and timely discontinuation of the drug can avoid sight-threatening complications.

Conclusion: This case underscores the importance of early recognition and prompt management of ocular complications, particularly as the use of bisphosphonates continues to increase.