Background: In Colombia, INVIMA has documented 11 cases of adverse events related to bisphosphonate therapy, underscoring the clinical importance of recognizing rare complications such as ocular inflammation following zoledronic acid infusion. These adverse effects, though infrequent, can lead to significant morbidity—including partial vision loss and other associated symptoms—necessitating prompt diagnosis and management.
Objectives: The primary objective of this case report is to describe the clinical presentation, diagnostic process, and management of zoledronic acid-induced ocular adverse effects in a patient with osteopenia. Additionally, the report aims to review current literature on bisphosphonate-associated ocular complications, emphasizing the need for early recognition and interdisciplinary follow-up to mitigate the risk of permanent visual impairment.
Methods: Case report
Results: The patient developed ocular symptoms four days after a 5 mg intravenous infusion of zoledronic acid. She reported headache, photophobia, ocular pain, and decreased visual acuity in the left eye, along with mandibular pain and limited jaw mobility, plus a progression in hearing loss; cardiovascular evaluations remained normal.
Over three months, her headache and photophobia resolved, and her visual acuity improved by approximately 60% based on subjective reports and ophthalmologic assessment. Mandibular symptoms and hearing loss remained stable, with no new cardiovascular events observed.
These findings, along with the clear temporal relationship to drug administration, support a probable adverse reaction to zoledronic acid per WHO criteria, emphasizing the need for vigilant monitoring and early intervention in patients receiving bisphosphonate therapy.
Conclusions: This case highlights a serious yet underrecognized adverse reaction associated with zoledronic acid therapy. The development of ocular inflammation, including uveitis, after bisphosphonate administration has been documented in pharmacovigilance reports and case studies, emphasizing the need for heightened awareness. While such events remain rare, their occurrence can lead to significant morbidity, including visual impairment, if not promptly identified and managed. Reports from INVIMA and other regulatory agencies also reinforce the causal association between bisphosphonates and ocular complications, warranting careful monitoring, patient education, and timely ophthalmologic evaluation in individuals receiving these medications. Given the increasing use of zoledronic acid for osteoporosis management, future research should focus on elucidating the mechanisms underlying these adverse effects and establishing preventive strategies to enhance drug safety.
