Zoledronic acid-induced sclerokeratouveitis in a patient with metastatic breast carcinoma

A 63-year-old woman received zoledronic acid for the treatment of skeletal metastases from medullary carcinoma of the breast. A day later, she developed pain and swelling in the left eye. The diagnosis of left eye sclerokeratouveitis was made by external examination, slit lamp, and fundus examination, supported by optical coherence tomography (OCT) and B-scan findings. Zoledronic acid was discontinued. The patient was treated with oral steroids and topical steroids. On follow-up, there was complete resolution of sclerokeratouveitis in the left eye. The periocular and ocular inflammation caused by bisphosphonates can be successfully treated with systemic and topical steroids along with the discontinuation of the inciting drug. This is the first reported case of zoledronate-induced ocular inflammation with intraocular imaging findings. Oncologists and ophthalmologists should be aware of this side effect of zoledronic acid.