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The localized eyelid erythema of active GO can affect either the eyelid close to the margin, where it may be confused with the much more common condition of blepharitis, or more commonly the area known as the preseptal eyelid, where maximal swelling occurs (Fig. 6). Comparison with the rest of the face helps determine what is abnormal for that individual and therefore likely to represent active GO. Note that localized eyelid erythema can occasionally persist for years.

Fig. 6. Assessment of eyelid erythema. a Normal appearance. b Pretarsal erythema (black arrows). c Preseptal erythema (white arrows).

Fig. 7. Assessment of conjunctival redness. a Normal appearance. b Moderate redness, excluding the redness of the caruncle (white arrow) and plica (black arrow). c Severe redness.