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The active phase of GO is the period when the patient is most likely to be symptomatic, commonly presenting with grittiness, photophobia, watering, and/or orbital aching – either gaze evoked or spontaneous. Patients will often have noticed a change in the severity of other features over the previous 3 months, for example worsening double vision. As we cannot directly identify the degree of orbital inflammation, i.e., activity, the classical signs of inflammation are used as its surrogate markers. In addition, if there has been a change in severity of any feature, worsening or improvement, then this also suggests that the disease is active.