zoledronic acid. Our case mirrored these previously reported cases with onset being between 24 and 48 h after infusion initiation, bilateral involvement, and a good response to topical steroid treatment with bisphosphonate discontinuation.With regard to our patient, the conjunctivitis affected primarily the inferior fornix raising the possibility of an allergic response to the topical antibiotic; however, she does not have a history of atopy and has no previous exposure to chloramphenicol, making such a severe reaction unlikely to be due to the primary exposure to the ointment. There is the possibility that the inflammation may be a consequence of the primary pathology; however, there are no reports in the literature of anterior uveitis being associated with either MGUS or multiple myeloma and with the evidence detailed above regarding other bisphosphonates, we must assume that the uveitis is secondary to the treatment. It would be unethical to rechallenge the patient to see if a recurrence occurred.Bisphosphonates are being used successfully in an increasingly broad range of disorders and with their increasing use, the ophthalmology and haematology communities should be aware of the potential ocular side effects. Case report ReferencesA 45-year-old lady has been attending the outpatient department for the past 20 years. She has a history of recurrent episodes of episcleritis, scleritis, and anterior uveitis which was controlled by topical steroids, mydriatics, and oral nonsteroidal anti-inflammatory drugs. A full systemic evaluation was carried out during the early stage revealed erosive changes of the sacroiliac joint compatible with ankylosing spondylitis in addition to being positive for HLA-B27. She presented 3 years ago to the accident and emergency department with a painful, red swollen left outer ear and was admitted to the ENT ward. She was treated with intravenous antibiotics for possible infective perichondritis but did not respond. In addition, her right eye was red and painful, and she also complained of experiencing intermittent joint pains with swelling of the left ankle. Of importance in her medical history was a 12-year history of sudden hearing loss in her right ear of unknown cause, and she has also recently been diagnosed with hypertension.

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