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You can do things from infusing a fourth gem onto a weapon, upgrading some of the weapon's base stats, and even purify gems which will remove a negative effect on it.
After awhile, things get expensive and from my playtesting Insanity 2 is the most efficent difficulty for farming them since you barely get any extra for doing them past that which makes the extra difficulty not worth the headache.
You can get orbs from boss enemies in the main campaign as well, but I'm not sure if you need to complete all the trial shrines before that starts happening or not.