It will come as no surprise that sociologists have great difficulty in agreeing on a definition of what it means to be healthy. Health can be defined in terms of the absence of disease, sometimes described as a negative approach to health. This is contrasted with a positive definition such as that provided by World Health Organisation; not merely an absence of disease, but a state of complete physical, mental, spiritual and social well-being.

There are three concepts of health; these are holistic, positive and negative. A person can have one or more concept of health. In the health and care sectors, care professionals would adopt a holistic approach to care and support. They see their role as addressing the needs of the whole person rather than specific issues or identified problems.

A holistic health is the belief that being healthy means being without any physical disorders or diseases and being emotionally uncomfortable, people with this view are likely to label themselves as ill when they experience a wide range of unpleasant feelings, not just physical discomfort or pain.

A positive conceptof health is the belief that being healthy is a state achieved by continuous effort. People with this belief take active steps to maintain their health. They will take credit for continued absence from disease and blame themselves if they develop symptoms.

A negative conceptof health is the view that being healthy is the absence of illness- not having any symptoms of disease, pain or distress. People with this view are likely to believe that good health is normal and to take it for granted they are well. They assume that they do not need to take any actions to keep healthy. Unlikely to think of themselves as ill when they have minor discomfort caused by colds or headaches, or when they feel tired or depressed.

A person with complex needs, for example a young mother with multiple sclerosis, may be supported by a range of professionals. These would include a GP, a community nurse, an occupational therapist, a social worker and a health visitor, often referred to as a multidisciplinary team. They will each have their particular roles and responsibilities for her care and support, but they will want to carry out a holistic assessment; they will recognize the importance of the young woman's wider needs when providing their specialist care.

Hyphema is blood in the front area of the eye.

Hyphema is usually caused by trauma to the eye. Other causes of bleeding in the front chamber of the eye include:

• Blood vessel abnormality
• Cancer of the eye
• Severe inflammation of the iris

• Bleeding in the front portion of the eye
• Eye pain
• Light sensitivity
• Vision abnormalities

• Eye examination
• Intraocular pressure measurement (tonometry)
• Ultrasoundtesting

In some mild cases, no treatment is needed. The blood is absorbed in a few days.

The health care provider may recommend bed rest, eye patching, and sedation to reduce the likelihood of recurrent bleeding.

Eye drops to decrease the inflammation or lower the intraocular pressure may be used if needed.

The ophthalmologist may need to remove the blood, especially if the intraocular pressure is severely increased or the blood is slow to absorb again. You may need to stay in a hospital.

The outcome depends upon the amount of injury to the eye. Patients with sickle cell disease are more likely to have eye complications and must be monitored more carefully.

Severe vision loss can occur.

• Acute glaucoma
• Impaired vision
• Recurring bleeding

Call your health care provider if you notice blood in the front of the eye or you have a traumatic eye injury. You will need prompt diagnosis and treatment by an ophthalmologist.

Many eye injuries can be prevented by wearing safety goggles or other protective eye wear. Always wear eye protection while playing sports such as racquetball, or contact sports such as basketball.

Tingey DP, Shingleton BJ. Glaucoma associated with ocular trauma. In: Yanoff M, Duker JS, eds. Ophthalmology. 3rd ed. St. Louis, Mo: Mosby Elsevier; 2008:chap 10.17.

Review Date: 11/08/2010

Daniel E. Bustos, MD, MS, Private Practice specializing in Comprehensive Ophthalmology in Eugene, OR. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

Fluorescein angiography is an eye test that uses a special dye and camera to look at blood flow in the retina and choroid, the two layers in the back of the eye.

Retinal photography; Eye angiography

Eye drops that make the pupil dilate will be given. You will be asked to place your chin on the camera's chin rest and your forehead against a support bar to keep your head still during the test.

The health care provider will take pictures of the inside of your eye. After the first group of pictures are taken, a dye called fluorescein is injected into a vein, usually at the bend of your elbow. Then, a special camera takes pictures as the dye moves through the blood vessels in the back of your eye.

You will need someone to drive you home, because your vision may be blurred up to 12 hours after the test.

You may be told to discontinue drugs that could affect the test results. Tell your health care provide about any allergies, particularly reactions to iodine.

You must sign an informed consent form. You must remove contact lenses before the test.

Tell the health care provider if you may be pregnant.

When the needle is inserted, some people feel moderate pain, while others feel only a prick or stinging sensation. Afterward, there may be some throbbing.

When the dye is injected, you may have mild nausea and a warm sensation. These symptoms are usually very brief.

The dye will cause your urine to be darker, and possibly orange in color, for a day or two after the test.

This test is done to see if there is proper blood flow in the blood vessels in the two layers in the back of your eye (the retina and choroid).

It can also be used to diagnose problems in the eye or to determine how well certain eye treatments are working.

A normal result means the vessels appear a normal size, there are no new abnormal vessels, and there are no blockages or leakages.

If blockage or leakage is present, the pictures will map the location for possible treatment.

An abnormal value on a fluorescein angiography may be due to:

• Blood flow (circulatory) problems, such as blockage of the arteries
• Cancer
• Diabetic or other retinopathy
• High blood pressure
• Inflammation or edema
• Macular degeneration
• Microaneurysms -- enlargement of capillaries in the retina
• Tumors
• Swelling of the optic disc

Additional conditions under which the test may be performed:

• Retinal detachment
• Retinal vessel occlusion
• Retinitis pigmentosa

There is a slight chance of infection any time the skin is broken. Rarely, a person is hypersensitive to the dye and may experience:

• Dizziness or faintness
• Dry mouth or increased salivation
• Hives
• Increased heart rate
• Metallic taste in mouth
• Nausea and vomiting
• Sneezing

Serious allergic reactions are rare.

Your urine will be darker, and possibly orange in color, for a day or two after the test.

The test results are harder to interpret in people with cataracts.

Maguire JI, Federman JL. Intravenous fluorescein angiography. In: Tasman W, Jaeger EA, eds. Duane's Ophthalmology. 15th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2009:chap 44.

Ciardella AP, Kaufman SR, Yannuzzi LA. The use of fluorescein angiography in acquired macular diseases. In: Tasman W, Jaeger EA, eds. Foundations of Clinical Ophthalmology. 15th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2009:chap 113F.

Review Date: 07/28/2010

Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; Franklin W. Lusby, MD, Ophthalmologist, Lusby Vision Institute, La Jolla, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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