Firework-related Ocular Injuries Research Articles

Occurrence and outcome of firework-related ocular injuries in Switzerland: A descriptive retrospective study

BackgroundFirework-related ocular injuries (FWROI) are a major cause of preventable visual impairment. This study aimed to analyze the occurrence and outcome of FWROI in Switzerland.MethodsThis retrospective multicenter study included patients with FWROI from seven centers in Switzerland from January 2009 to August 2020. Demographic information, type of injuries, medical and surgical treatments, the best corrected visual acuity (BCVA) at baseline and end of follow-up, occurrence and type of secondary complications, and duration of hospitalization were analyzed.ResultsA total of 105 patients (119 eyes) with a mean age of 27.1 ± 15.9 years were included in the study (71.4% male patients; 29.5% underage). Most injuries occurred around New Year’s Eve (32.4%) and the Swiss national holiday on 1 August (60.9%). The most common anterior segment findings were conjunctival or corneal foreign bodies (58%), whereas Berlin’s edema was the most common posterior segment finding (11.4%). Globe ruptures were found in four patients. The mean BCVA in all patients at first presentation was 0.4 ± 0.8 logMAR and improved to 0.3 ± 0.8 logMAR at last follow-up. A primary surgical intervention was performed in 48 eyes (40.3%). Hospitalization directly after the trauma was necessary for 18 patients for a mean of 5.8 ± 4.1 days, and a total of 4.9 ± 7.6 follow-up visits were needed.ConclusionThis study provides the first data on FWROI in Switzerland, which are helpful for further preventive and educational programs and comparisons with other countries.

Firework-related Ocular Injuries During Festival Season: A Hospitalbased Study in a Tertiary Eye Care Center of Nepal.

Firework-related ocular injuries are an important cause of preventable ocular injuries and are common during the festival season. Despite the strict legislation in Nepal, the use of a firework is still commonly used during Tihar and Chaath festivals. To evaluate demographic distribution, mode, causative firework, type of fireworks-related ocular injuries, and visual outcome at a tertiary eye hospital in Eastern Nepal. This is a hospital-based prospective interventional study. All the patients with firework-related injuries who attended the emergency and outpatient department of SCEH, Lahan, during or within 1 month of the festival season (Tihar and Chaath puja) were included in this study. Total of 65 eyes were included. The left eye was involved in 49.1%, 82.5% were males. Mean age of the patients was 15.3±14.7 years (range 5yr - 75yr). Children less than 16 years were predominantly involved (77.2%). Firecrackers (56.1%) were the most common type of fireworks causing injury. The closed globe injuries were more (78.5%) compared to open globe injuries (21.5%). Surgical management was done in 50.9% of cases. Following management visual acuity of most patients improved. Only 8 eyes (12.3%) had visual acuity less than 3/60 after management compared to 28 eyes (43.1%) at the time of presentation. Firework related ocular injuries are important causes of preventable blindness. A combined approach of public awareness about the possible dangers, preventive measures, early treatment by trained primary ophthalmic care, and implementation of strict legislations are essential to reduce blindness due to this preventable cause.

Firework related ocular injuries in Eastern India - A clinico-epidemiological analysis.

Purpose:Ocular trauma is one of the major preventable causes of ocular morbidity and blindness in children and young adults. Firework injuries account for 20% of ocular trauma. The purpose of this study was to describe the clinical profile and assess the severity of the ocular injuries sustained from fireworks in Eastern India mainly during the festive season.Methods:This was a retrospective, hospital-based case study of patients with ocular injuries sustained from fireworks during the year 2017–2020. The study was conducted at a tertiary care hospital in Eastern India. Demographic details, type of injury, duration of injury, visual status, diagnostic tests, and management were recorded.Results:Sixty-five patients were reported to suffer from firework-related ocular injuries. The majority of cases were male (51/78.5%). The mean age was 21.78 ± 16.82 years (range: 0–90 years). Children and young adult males were mostly affected (n = 40, 61.5%). Most common offending agent was the bottle rockets (n = 23, 35.4%), followed by bomb and crackers in (n = 18, 27.7%). Majority of the injuries occurred at home environment (n = 37, 56.9%), followed by street (n = 15, 23.1%). About (n = 39, 60%) of the injuries occurred among bystanders. About 40 cases (61.5%) hailed from rural areas. The majority of the cases (n = 46, 70.8%) suffered from closed globe injuries and surgical intervention was required in (n = 40, 61.5%) of the cases. The mean length of hospital stay of fewer than 5 days was required in (n = 42, 64.6%). The final visual acuity of 6/18 or better was achieved in 41 cases (63.1%).Conclusion:Ocular injuries from fireworks remain a public health problem. Awareness among the masses, preventive measures, and strict implementation of government legislation may help in bringing down the incidence of firework-related ocular morbidity and blindness.

Assessment of Firework-Related Ocular Injury in the US

Fireworks are popularly used for recreation but can lead to potentially blinding injuries. Studies quantifying the trend and national prevalence of firework-related ocular injuries are limited. To characterize firework-related ocular injuries treated in emergency departments (EDs) in the US from 1999 to 2017. This cross-sectional study used the National Electronic Injury Surveillance System, a stratified probability sample of more than 100 hospital-affiliated US EDs representing more than 5300 nationwide hospitals. Deidentified individuals in the National Electronic Injury Surveillance System database who experienced eye injury due to fireworks between January 1, 1999, and December 31, 2017, were included. Analysis began February 2019. Annual prevalence of firework-related ocular injury, firework type stratified by demographic information, diagnosis, event location/date, and patient disposition. A total of 34 548 firework-related ocular injuries were seen in US EDs during the 19-year study period (estimated from 1007 individuals in the National Electronic Injury Surveillance System database). Overall, 664 individuals (65.9%) were 18 years or younger, 724 (71.9%) were male, and 512 (50.8%) were white. Twenty-eight patients (2.8%) sustained a ruptured globe, while 633 (62.9%) sustained ocular burn injuries, 118 (11.7%) had ocular foreign bodies, 97 (9.6%) had conjunctival irritation, and 46 (4.6%) experienced other severe eye trauma. Of 1007 individuals, 911 (90.5%) were treated and released without transfer, while 87 (8.7%) required admission or transfer to another hospital. The most common specified firework types included firecrackers (193 [19.2%]), bottle rockets (177 [17.6%]), sparklers (88 [8.7%]), roman candles (66 [6.6%]), and novelty devices (65 [6.5%]) (eg, poppers and snappers). Bottle rockets disproportionately caused the most severe injuries, including ruptured globe (odds ratio, 5.82; 95% CI, 2.72-12.46; P < .001). A total of 411 cases (74.9%) occurred at home. Injuries most commonly occurred near the time of Independence Day and New Year's Day: 707 patients (70.2%) presented in July, 74 (7.4%) in June, 101 (10.0%) in January, and 47 (4.7%) in December. These findings support that firework-related ocular injuries range from mild irritation to ruptured globe, and most occur frequently in those who are young, male, and white. Focused preventive methods and regulations may be imperative in decreasing fireworks-related ocular morbidity, namely from bottle rockets and especially near national holidays.

Profile of firecracker injuries of the eye during Diwali: A tertiary eye-care center study

Aims and Objectives: The aim was to study the demographic pattern, clinical features, management, and prognosis of the patients with firecracker-related ocular injuries during Diwali. Materials and Methods: This institution-based prospective study was done in 30 patients who attended eye emergency and outpatient department (OPD) of Calcutta National Medical College and Hospital, West Bengal, during the period of 1 week of Diwali in 2016 and 2017. The parameters studied were the age and sex of the patients, type of firework (crackers and sparklers), eye involved, severity of injury with respect to active and passive participants, management, severity of injury, and visual outcome with respect to type of firecrackers. Results: A total of 30 patients attended eye OPD and emergency during our study period, of which 23 (76.7%) were male and 7 (23.3%) were female. All of them were in the pediatric age group (1–15). All patients were examined on the day of injury. Patients between 6 and 10 years of age were most commonly affected. Four cases (13.3%) were open-globe injuries and 26 (86.7%) cases were closed-globe injuries. Visual acuity varied from 6/9 to no perception of light. The most common firework involved was the crackers. Conclusions: Careless and indiscriminate use of firecrackers may sometimes lead to serious ocular damage. In India, use of fireworks is quite common during various festivals, particularly during Diwali, thus fireworks-related ocular injuries are important causes of blindness. This prospective study revealed the presentation and outcome of ocular injuries due to firecrackers in this area of mixed culture during this festive week.

Spectrum of ocular firework injuries in children: A 5-year retrospective study during a festive season in Southern India.

Purpose:Ocular trauma is a major cause of acquired monocular blindness in children. Firework injuries account for 20% of ocular trauma. The purpose of our study was to document the profile of ocular firework injuries in children during the festive season of Diwali and to determine the prevalence of unilateral blindness in them.Materials and Methods:A retrospective chart analysis of ocular firework injury in children during the festival of Diwali from 2009 to 2013, conducted in a tertiary care eye center in Tamil Nadu, Southern India. Children below 18 years of age with ocular firework injuries who presented to the emergency department for 3 consecutive days - the day of Diwali, 1 day before, and 1 day after Diwali - were included in this study.Results:Eighty-four children presented with firework-related ocular injuries during the study period. Male to female ratio was 4:1 with mean age 9.48 ± 4 years. Forty-four percentage required hospitalization. The prevalence of unilateral blindness in children due to fireworks was found to be 8% (95% confidence interval - 2–13%).Conclusion:Vision 2020 gives high priority to avoidable blindness, especially in children. In our study, for every 12 children who presented with firecracker injury, one resulted in unilateral blindness. This is an avoidable cause of blindness. Awareness needs to be created, and changes in policy regarding sales and handling of firecrackers including mandatory use of protective eyewear should be considered.

Five-year study of ocular injuries due to fireworks in India

To study the demographic profile, cause, type and severity of ocular injuries, their complications and final visual outcome following fireworks around the time of Deepawali in India. Case records of patients who presented with firework-related injuries during 2005-2009 at the time of Deepawali were reviewed. Data with respect to demographic profile of patients, cause and time of injury, time of presentation and types of intervention were analyzed. Visual acuity at presentation and final follow-up, anterior and posterior segment findings, and any diagnostic and surgical interventions carried out were noted. One hundred and one patients presented with firework-related ocular injuries, of which 77.5% were male. The mean age was 17.60±11.9years, with 54% being ≤14years of age. The mean time of presentation was 8.9h. Seventeen patients had open globe injury (OGI) and 84 had closed globe injury (CGI). Fountains were the most common cause of CGI and bullet bombs were the most common cause of OGI. Mean log MAR visual acuity at presentation was 0.64 and 1.22 and at last follow-up was 0.09 and 0.58 for CGI and OGI, respectively (p<0.05). Patients with CGI had a better visual outcome. Three patients with OGI developed permanent blindness. Factors associated with poor visual outcome included poor initial visual acuity, OGI, intraocular foreign body (IOFB), retinal detachment and development of endophthalmitis. Firework injuries were seen mostly in males and children. Poor visual outcome was associated with poor initial visual acuity, OGI, IOFB, retinal detachment and development of endophthalmitis, while most patients with CGI regained good vision.

EPIDEMIOLOGY OF FIREWORK INJURIES CHAHAR SHANBEH SOORI EVE CEREMONY, IN IRAN

Abstract Background and aim: Many people sustain injuries in Chahar Shanbeh Soori ceremony that is held at the final hours of the last Tuesday of every year. This study aimed to identify epidemiology of injuries that caused in this ceremony in 2009. Materials and Methods: At this epidemical descriptive study, data and specifications of people, injured in Chahar Shanbeh Soori ceremony, were collected by universities of medical sciences using standard and specified questionnaires and then sent to Preventive of Accident and Emergency Medicine Department to be evaluated. Demographic and epidemic information, as epidemic areas, states, type of explosive materials and jobs of injured people were studied. At the end, data were compared with information of a few years ago. Results: On the whole, 1817 people were injured in this ceremony (%83.2 male and 16.8 female), and average age of them was 20.9 ± 10 years old. Subgroup of 15-24 years old, are the most injured people and the most injuries, were caused by inflammable materials. More than one third of injuries of organs are related to hands (%34.4). %81.4 of injured people, were outpatients, and the rest were hospitalized. Conclusion: as the most group of injured people, were students injured during game with inflammable materials, warning programs, should presented to parents via media and schools. Keywords : Injury, Damage, ceremony, burn, gaming with fire, Chahar Shanbe Soori, inflammable materials REFERENCES -American Academy of Pediatrics (2001). Committee on Injury and Poison Prevention. Fireworks- related injuries to children. Pediatrics . 108 (1) 190–191. -Fogarty BJ Gordon DJ (1999). Firework related injury and legislation: The epidemiology of firework injuries and the effect of legislation in Northern Ireland. Burns. 25 (1) 53-56 -Isa AR Moe H (1991). Fireworks related injuries during Hari Raya festival in Hospital University Sains Malaysia 1986 to 1990. The Medical Journal of Malaysia. 46 (4) 333–7. -Jing Y Yi-qiao X Yan-ning Y and et al (2010). Clinical analysis of firework-related ocular injuries during Spring Festival 2009. Graefes Arch Clin Exp Ophthalmol. 248 (3) 333–338. -Mansouri MR Mohammadi SF Hatef E and et al (2007). The Persian Wednesday Eve Festival ‘‘Charshanbe-Soori’’ M reworks eye injuries: a case series. Ophthalmic Epidemiology. 14 (1) 17–24. -Mohammad M Al-Qattan, Al-Tamimi A.S (2009). Localized hand burns with or without concurrent blast injuries from M reworks. Burns. 35 (3) 425–429. - Newell FW Vail D (1972). Fireworks blindness. Am J Ophthalmol. 74 (1) 167–168. -Puri V Mahendru S Rana Rand et al (2009). Firework injuries: A ten-year study. Journal of Plastic, Reconstructive Aesthic Surgery. 62 (9) 1103–11. -Saadat S Naseripour M Smith GA (2010). The health and economic impact of M reworks-related injuries in Iran: A household survey following the New Year’s Festival in Tehran. Injury. 41 (7) 28-33. -See LC Lo SK (1994). Epidemiology of M reworks injuries: The National Electronic Injury Surveillance System, 1980– 1989. Annals of Emergency Medicine. 24 (1) 46–50. -Sheller J Muchardt O Jonsson Band et al (1995). Burn injuries caused by M reworks: effect of prophylaxis. Burns. 21 (1) 50–3. -Tavakoli H and et al (2011). Firework-related Injuries in Tehran’s Persian Wednesday Eve festival (CHAHARSHANBE SOORI). The Journal of Emergency Medicine. 40 (3) 340-5 -Vassilia K Eleni P Dimitrios T (2004). Firework-related childhood injuries in Greece: a national problem. Burns. 30 (2) 151–153. -Zohar Z Waksman I Stolero J et al (2004). Injury from M reworks and M recrackers during holidays [Hebrew]. Harefuah. 143 (10) 698–701.

Prognostic Factors and Visual Outcome for Fireworks-Related Burns During Spring Festival in South China

The aim of this study was to evaluate the clinical features and the visual results of fireworks-related ocular burn injuries and to determine the prognostic factors. The authors conducted a prospective observational study of 53 eyes of 46 consecutive patients with fireworks-related ocular injury who visited Zhongshan Ophthalmic Center during the Spring Festival in Southern China. Eyes were graded using an ocular trauma classification system, which included age of the patient. Patients were followed up for a minimum of 5 months. Best-corrected visual acuity at the last follow-up was considered the final visual outcome. Data were analyzed with SPSS version 13.0 (SPSS, Inc., Chicago, IL). Results of statistical tests were considered statistically significant for P < .05. Almost all patients (89.1%) were male with a mean age of 14.3 ± 8.5 years. There was preponderance of young patients, with 63.0% (29) of the patients being younger than 15 years. In addition to their ocular injuries, 23 patients (50.0%) also had eyelid and/or facial burns. The most common initial anterior segment injuries were open-globe injuries (42, 79.3%), conjunctival burns (16, 30.2%), and foreign bodies (18, 34.0%). Others were traumatic cataract, lens subluxation and dislocation, and vitreous hemorrhage. Management after first aid included pars plana vitrectomy (9, 17.0%), aspiration of cataract (18, 34.0%), retinal reattachment (8, 15.1%), and enucleation. Amniotic membrane grafts were used in 11 patients (20.8%) with serious conjunctiva burns and corneal contusions and abrasions who were thought to have a good prognosis. Fireworks-related ocular injuries included a variety of clinical manifestations. Examinations such as B scan, optical coherence tomography, and ultrasound biomicroscopy helped to make a correct diagnosis and plan further treatment. Fireworks-related ocular injuries commonly affect young male subjects of Southern China. Visual outcomes were frequently poor and visually devastating. Laws should be passed to forbid the personal use of fireworks in China, and public education on the sale and use of fireworks should be increased.

Ocular trauma score in transferred fireworks-related ocular injuries: a case series

Our aim was to review the characteristics of transferred fireworks-related ocular damage and to evaluate the prognostic value of the ocular trauma score (OTS) for these injuries. This study included 22 transferred patients (19 male, 3 female; mean age 22.6±14.9 years) (25 eyes). The data were retrospectively reviewed, including the characteristics of the geography, types of fireworks, status of injuries, therapeutic procedures, and the best-corrected visual acuity (BCVA). All the injured eyes were classified using the OTS at the time of the initial examination. Twenty eyes (80%) were in OTS category 1, three eyes (12%) were in OTS category 2, and two eyes (8%) were in OTS category 3. All cases received surgical therapy. Six eyes (24%) were enucleated, four (16%) of which achieved an improvement in their final BCVA. There was a statistically significant improvement in final BCVA between OTS category 1 and the other two OTS categories (p=0.016). The aforementioned transferred fireworks-related ocular injury cases occurred mainly in young adults, men and active participants, all of which incurred serious vision loss and blindness. The OTS is quite effective for classifying the status and estimating the prognosis of transferred fireworks-related ocular injuries.

Clinical analysis of firework-related ocular injuries during Spring Festival 2009

To document the clinical features, management and visual outcome of fireworks-related ocular injuries during the Spring Festival. A retrospective analysis of all patients with fireworks-related ocular injuries attending the Department of Ophthalmology in Renmin Hospital of Wuhan University from January 20 to February 10, 2009. Age, gender, laterality, type of fireworks, location of incident, initial best-corrected visual acuity (BCVA), diagnosis, management, and final BCVA at last follow-up were documented. Relevant clinical features and visual outcome were evaluated. We observed 25 eyes in 24 patients. Injuries were more frequent in children (ten, 41.7%), males (19, 79.2%), and as open globe injury (15, 62.5%). The most common pyrotechnical products causing accidents were firecrackers (12, 50%). Rural residents had significantly higher rates of injury compared to urban residents (P = 0.023). Of 25 eyes, the most common injuries were corneal/scleral/corneoscleral open globe trauma (15, 60%), traumatic cataract (14, 56%), vitreous hemorrhage (seven, 28%) and retinal detachment (seven, 28%). Most eyes (23, 92%) received surgical intervention, including one (4%) eye enucleation. Vitrectomy was the most surgical treatment. After management, visual outcomes showed statistically significant improvement (P = 0.008). Initial BCVA correlated strongly with final BCVA (P = 0.010). Fireworks-related ocular injuries occur mainly in children, males and rural settings, are frequently severe and visually devastating. Therefore, preventive measures should be strengthened, including public education and legal restriction on the sale and use of fireworks.

Ocular Surface Reconstruction for Thermal Burns Caused by Fireworks

To describe 6 eyes with severe firework-related ocular surface injuries that were treated by limbal stem cell transplantation combined with amniotic membrane transplantation (AMT). Six eyes of 6 patients with firework-related ocular injuries were retrospectively studied. All subjects were men, with age ranging from 9 to 26 years. All patients were in chronic stage of thermal injury, and all had total limbal stem cell dysfunction and subsequent conjunctival fibrosis. They had limbal stem cell transplantation (1 had an allograft and 5 had autograft transplantation) combined with AMT to restore vision. Mitomycin C was used in 1 eye intraoperatively. After ocular surface reconstruction using limbal stem cell transplantation combined with AMT, corneal epithelialization was achieved in 4 eyes after a mean duration of 20.8 +/- 12.2 days (range, 4-33 days). After a mean follow-up period of 36 months (range, 5-87 months), marked reduction of fibrosis was noted in all eyes. At last examination, the corneal surface was covered by corneal-phenotype epithelium in 4 eyes, and the remaining 2 eyes had conjunctivalization. The cornea was optically clear in 3 eyes, with corrected visual acuity of 20/100 in these 3 eyes. Both eyes that developed conjunctivalization had massive fibrosis preoperatively and severe eyelid deformities. Although severe firework-related ocular surface injuries were difficult to treat, limbal stem cell transplantation combined with AMT enable some success in cosmetic and visual outcome. Management of eyelid abnormalities and ocular surface fibrosis seemed to be a key to success in visual rehabilitation.

Visual Outcome after Fireworks Injuries

The epidemiology and prognosis of fireworks-related injuries treated at a tertiary eye care center in less developed nations remain unknown. We conducted a prospective observational study that enrolled all consecutive eyes with fireworks-related ocular injury visiting our trauma clinic during a 1-year period. Eyes were graded by ocular trauma classification and followed for 6 months at least. Best corrected visual acuity (BCVA) at 6 months was considered the final visual outcome. Data were analyzed. Twenty-five (96%) of a total of 26 patients enrolled during study period were male patients and 13 (50%) were younger than 15 years. The type of fireworks involved was a bottle rocket in 38.5%. Factors significantly associated with better final visual outcome were better BCVA at presentation (p = 0.041), absence of bottle rocket injury (p = 0.028), closed globe injury (p = 0.028), absence of relative afferent pupillary defect (p = 0.019), absence of intraocular foreign body (p = 0.026), and absence of endophthalmitis (p = 0.006). Besides poor visual outcome, bottle rocket injuries were more frequently associated with facial lacerations, intraocular foreign body, and endophthalmitis development. Fireworks-related ocular injuries commonly affect young male subjects of northern India. Visual outcome is better in eyes having better initial BCVA or closed globe injury and if relative afferent pupillary defect, bottle rocket injury, intraocular foreign body, and endophthalmitis are absent.

Profile of Fireworks Related Ocular Injuries (FROI) from Western India

Profile of Fireworks Related Ocular Injuries (FROI) from Western India