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Ang T, Chaggar V, Tong JY, Selva D. Medication-associated orbital inflammation: A systematic review. Surv Ophthalmol 2024; 69:622-631. [PMID: 38490453 DOI: 10.1016/j.survophthal.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 02/28/2024] [Accepted: 03/11/2024] [Indexed: 03/17/2024]
Abstract
We performed a comprehensive systematic review to identify medication-associated orbital inflammation and to characterize its clinico-radiological features. We reviewed English-language articles describing medication-associated orbital inflammation (i.e., orbital myositis, dacryoadenitis and orbital fat) published to June, 2023. Isolated inflammation of the intraocular structures or globe alone (i.e. uveitis, scleritis, optic neuritis and perineuritis) were excluded. In medication-associated orbital inflammation, the extraocular muscles are preferentially affected, occurring in isolation or in combination with other orbital and/or intraocular structures. Clinico-radiological manifestations may be non-specific; however, certain medications may be distinguished according to the presence of systemic prodrome, laterality, associated intraocular inflammation, and predisposition to involve certain orbital structures. Rapid identification, discontinuation of the provoking medication, and systemic corticosteroid therapy (if appropriate) typically achieves a favorable visual prognosis. As new medications become adopted by clinicians, rare adverse effects will be further delineated.Medication-associated orbital inflammation is an important diagnostic consideration in orbital inflammatory disease. A careful medication history and clinical assessment may be revealing, permitting timely discontinuation of the offending agent and initiation of appropriate management.
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Affiliation(s)
- Terence Ang
- The University of Adelaide, Adelaide, South Australia, Australia.
| | - Viraj Chaggar
- The University of Adelaide, Adelaide, South Australia, Australia
| | - Jessica Y Tong
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Dinesh Selva
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Chartrand NA, Lau CK, Parsons MT, Handlon JJ, Ronquillo YC, Hoopes PC, Moshirfar M. Ocular Side Effects of Bisphosphonates: A Review of Literature. J Ocul Pharmacol Ther 2023; 39:3-16. [PMID: 36409537 DOI: 10.1089/jop.2022.0094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
In rare cases, bisphosphonates are well established to cause ocular inflammation, presenting as uveitis, episcleritis, scleritis, orbital inflammation, and/or conjunctivitis. Some reports of bisphosphonate-associated neuro-ophthalmic complications also exist. We identified 101 reports in the literature relating to bisphosphonate-associated ocular complications. In a great majority of cases, symptoms resolve after discontinuation of the drug and anti-inflammatory treatment. Many cases recur if rechallenged with the same bisphosphonate. First-generation nonamino bisphosphonates, including clodronate and etidronate, are not associated with ocular inflammation. Only 2nd- and 3rd-generation amino bisphosphonates, including pamidronate, alendronate, risedronate, ibandronate, and zoledronate are associated with these complications. The mechanism of bisphosphonate-induced ocular inflammation may be related to activation of γ/δ T cells or M1 macrophages. Intravenous forms, such as pamidronate and zoledronate, tend to have higher rates and faster onset of ocular inflammation, generally presenting within days of infusion. In oral bisphosphonates, such as alendronate and risedronate, these complications present with more sporadic timing. Rates of complications are also higher when bisphosphonates are used for malignancy, as doses tend to be higher compared with doses for osteoporosis.
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Affiliation(s)
| | - Chap-Kay Lau
- College of Medicine Phoenix, University of Arizona, Phoenix, Arizona, USA
| | - Mark T Parsons
- College of Medicine Phoenix, University of Arizona, Phoenix, Arizona, USA
| | | | | | | | - Majid Moshirfar
- Hoopes Vision Research Center, Hoopes Vision, Draper, Utah, USA.,Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, Utah, USA.,Utah Lions Eye Bank, Murray, Utah, USA
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Affiliation(s)
- Muhammad Faran Khalid
- Department of Medicine, Michael G. DeGroote School of Medicine, Hamilton, Ontario, Canada
| | - Jonathan Micieli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Kensington Vision and Research Centre, Toronto, Ontario, Canada
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Herrera I, Kam Y, Whittaker TJ, Champion M, Ajlan RS. Bisphosphonate-induced orbital inflammation in a patient on chronic immunosuppressive therapy. BMC Ophthalmol 2019; 19:51. [PMID: 30764790 PMCID: PMC6374910 DOI: 10.1186/s12886-019-1063-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 02/01/2019] [Indexed: 11/10/2022] Open
Abstract
Background To report a case of orbital inflammation after bisphosphonate infusion in a patient who was already receiving immunosuppressive therapy. Case presentation A 56-year-old woman presented to the ophthalmology clinic with acute onset of right eye pain 24 h after receiving her first Zolendronic acid infusion. She has a past medical history of chronic inflammatory demyelinating polyneuropathy, Sjogren’s syndrome, and systemic lupus erythematosus that have been controlled with immunosuppressive therapy for three years. Clinical ophthalmic exam and MRI studies were significant for right orbital inflammation. The patient was started on oral prednisone with rapid resolution of symptoms. Conclusions This is the first case report of a patient receiving chronic immunosuppressive therapy to develop orbital inflammation after Zoledronic acid infusion. In addition, it demonstrates that corticosteroids can be an effective first line therapy in treating orbital inflammation in similar patients. Physicians should be aware of this rare but serious potential side effect of bisphosphonates, and have bisphosphonate-related orbital inflammation on their differential for proper initiation of treatment.
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Affiliation(s)
- Isabella Herrera
- Department of Ophthalmology, University of Kansas School of Medicine, 7400 State Line Rd, Prairie Village, Kansas, USA
| | - Yong Kam
- Department of Ophthalmology, University of Kansas School of Medicine, 7400 State Line Rd, Prairie Village, Kansas, USA
| | - Thomas J Whittaker
- Department of Ophthalmology, University of Kansas School of Medicine, 7400 State Line Rd, Prairie Village, Kansas, USA
| | - Mary Champion
- Department of Ophthalmology, University of Kansas School of Medicine, 7400 State Line Rd, Prairie Village, Kansas, USA
| | - Radwan S Ajlan
- Department of Ophthalmology, University of Kansas School of Medicine, 7400 State Line Rd, Prairie Village, Kansas, USA.
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