Non-surgical management of thyroid eye disease: a pilot survey of oculoplastic surgeons.

PURPOSE: To investigate real-world practices in the non-surgical management of thyroid eye disease (TED) among oculoplastic surgeons across participating Asia-Pacific clinical settings.

METHODS

A structured 39-item online questionnaire was distributed between August and October 2023 to 40 eligible oculoplastic surgeons identified through the Asia Pacific Society of Ophthalmic Plastic and Reconstructive Surgery. The questionnaire assessed clinical experience, TED patient volume, and preferred non-surgical therapeutic approaches, including corticosteroids, immunosuppressive agents, orbital radiotherapy (ORT), biologic therapies, periocular injections, and micronutrient supplementation. Descriptive statistics were used because of the exploratory nature and small sample size of the survey.

RESULTS

Seventeen physicians completed the questionnaire, corresponding to a response rate of 42.5%. All respondents reported using glucocorticoids, and intravenous methylprednisolone was the predominant systemic treatment. A cumulative dose of 4.5 g, administered as 6 weekly infusions of 500 mg followed by 6 weekly infusions of 250 mg, was selected by 13 respondents (76.5%). Periocular injections were used by 11 respondents (64.7%), with triamcinolone acetonide being the most frequently used agent. Ten respondents (58.8%) reported using ORT. Immunosuppressive agents were used less frequently, with mycophenolate mofetil and methotrexate each reported by 3 respondents (17.7%). Biologic therapies included tocilizumab (4, 23.5%), rituximab (3, 17.7%), and teprotumumab (1, 5.9%). Selenium supplementation was reported only sporadically.

CONCLUSIONS

This exploratory survey demonstrates substantial variability in the non-surgical management of TED across participating Asia-Pacific settings. Given the small, non-random sample and uneven country representation, these findings should be interpreted as preliminary and hypothesis-generating rather than representative of the Asia-Pacific region as a whole.