The authors describe four patients with bisphosphonate induced orbital inflammation and review a further 25 cases in the literature. Intravenous zoledronate was the most common precipitant (76% of cases) with the mean time until onset of inflammation being three days (range one to 28 days). The orbital inflammation resolved in all but one patient with cessation of bisphosphonate treatment and commencement of steroid treatment. The exact nature of the steroid treatment was not described.