Ocular injuries from fireworks: the 11-year experience of a US level I trauma center

Abstract

PurposeCharacterize ocular trauma and visual outcomes from firework injuries at a level I trauma center.MethodsRetrospective review of all firework injuries at Harborview Medical Center between 2003 and 2013.ResultsThree hundred and twenty-seven patients sustained firework injuries, of which 100 (31%) sustained ocular injuries. The average age of all patients who sustained fireworks injuries was 24.2 years, 89% were male and 54% of injuries occurred within 48 h of 4 July. Ocular injuries were most commonly caused by mortars (24%) and rockets (22%). Rockets were associated with four times the frequency of ocular injuries as compared with non-ocular injuries (P<0.001). Spectators were more likely to sustain ocular injuries than non-ocular injuries (P=0.001). The most common injuries sustained were corneal abrasions (67%), hyphemas (42%), eyelid injuries (39%), and ruptured globes (17%). Twenty-eight percent of patients with ocular injuries required surgical intervention. Ruptured globes occurred in 17% of patients, with the majority being complex corneoscleral lacerations. Fifty-eight percent of patients who sustained ruptured globes were left with no light perception in the affected eye. Average follow-up was 188 days. Average visual acuity significantly improved from logMAR 1.8±1.6 at presentation to logMAR 1.3±1.8 at last follow-up.ConclusionsFirework-related ocular trauma frequently results in vision-threatening pathology. Prompt referral to and treatment by ophthalmologists is critical. This study documents the dangers inherent in the personal use of fireworks and provides data that may help guide public policy to decrease the frequency of these devastating injuries.

Figure 1

Percentage of injuries by firework type. The percentage of patients with ocular injuries and without ocular injuries are graphed separately by each type of firework. *signifies a significant difference between groups with respect to firework type (P<0.05).

Figure 2

Percentage of injuries by activity. The percentage of patients with ocular injuries and those without ocular injuries are graphed separately by each type of activity. *signifies a significant difference between groups with respect to activity (P<0.05).

Figure 3

Ocular injuries resulting from fireworks. The types of ocular injury seen in this study are graphed as a percentage of patients affected with values listed above each corresponding bar. Of the 39% of patients with eyelid injuries, 26% had margin-involving lacerations and 8% had canalicular lacerations.

Figure 4

Ruptured globes by firework type. Seventeen patients suffered a ruptured globe during our study period. Firework type is displayed with the percentage of rupture globes they caused with values listed above each corresponding bar.