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Multicenter Study
. 2025 Apr;263(4):1157-1165.
doi: 10.1007/s00417-024-06677-6. Epub 2024 Dec 4.

Significant increase of firework induced eye injuries in Germany and The Netherlands- are we doing enough to protect minors and bystanders?

Ameli Gabel-Pfisterer  1   2 , Stefan Johann Lang  3 , Daniel Boehringer  4 , Hansjürgen Agostini  4 , Lotte C de Geus  5 , Jan Tjeerd de Faber  5 ; German firework study group
Collaborators, Affiliations
Multicenter Study

Significant increase of firework induced eye injuries in Germany and The Netherlands- are we doing enough to protect minors and bystanders?

Ameli Gabel-Pfisterer et al. Graefes Arch Clin Exp Ophthalmol. 2025 Apr.

Erratum in

Abstract

Background: After 2 years of pandemic sales ban, on New Year`s Eve 2022/23 consumer firework articles were officially available again in Germany and the Netherlands.

Methods: In the Netherlands we prospectively and anonymously collected data on patients treated for firework induced eye injuries from 2009 on, in Germany since 2016.

Results: Around New Year ́s Eve 2022/23 the number of patients with firework inflicted eye injuries increased in the Netherlands to 133 and in Germany to 838. In both countries the participation of eye departments was 90%. The incidence of firework induced eye injuries in the Netherlands was 0,8 /100 000 in 2022/23, in Germany 1,0 /100 000 in 2022/23. Comparing age groups of minors with firework induced eye injuries, in the Netherlands, total numbers of children below 12 years was lower than total numbers of adolescents between 12 and 17 years. Yet, in Germany from 2016 on every year, total number of children below 12 years were higher than total number of adolescents. The number of patients who reported on being injured as bystander was between 34% in 2020/21 and 53% in both countries.

Conclusions: While the incidence of firework induced eye injuries in the Netherlands was reduced due to awareness campaigns and regulatory work, the incidence was increasing on the first New Year`s Eve after the pandemic regulations of consumer fireworks in Germany. Especially young children below 12 years need more protection in Germany. In both countries, effective measures of protection need to be implemented for protection of bystanders, whose numbers were low during the first pandemic years.

Key messages: What is known: overrepresentation of affected minors below 18 years and a rate of up to 50% of injured bystanders according to our data collection over 15 years in the Netherlands and 7 years in Germany What is new: In 2022/2023, total numbers of patients with fire work induced eye injuries in the Netherlands and Germany increased significantly after 2 years of pandemic regulations with a sales ban of consumer fire work articles In 2022/23, incidence of firework induced eye injuries is 1/100 000 in Germany, 0,8/100 000 in the Netherlands Among affected minors in Germany school children up to 12 years are at higher risk than adolescents.

Keywords: Bystander; Consumer fireworks; Firework induced eye injuries; Firework inflicted eye injuries; Incidence; Private fireworks; Protection.

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Conflict of interest statement

Declarations. Disclosure of potential conflicts of interest: All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript. Research involving human participants and/or animals: The anonymous, voluntary data collection protocols align with ethical guidelines exempting approval requirements, so we did not seek separate ethics approval for the registry. All registry submissions are de-identified upon submission per established ethics standards, ensuring patient privacy is completely upheld. Informed consent: While individual patient consent was waived, this decision was made after careful consideration. Waiving consent aims to reduce participation bias and ensure robust datasets that support impactful health research and improved patient outcomes. We believe the significant potential for public benefit justifies this protocol. Photographs were included after patients or parents´ consent for publication.

Figures

Fig. 1
Fig. 1
Total number of patients treated in eye departments for firework induced eye injuries per year around New Year`s Eve in the Netherlands and Germany. In the Netherlands, constant campaining and regulatory reduction of consumer firework operating time have led to a decrease of eye injurie numbers. In 2020/21 and 2021/22 a sales ban of consumer fireworks was effective in both countries in reducing eye injuries during the pandemic
Fig. 2
Fig. 2
Incidence of firework induced eye injuries per 100 000 inhabitants. The incidence in Netherlands, where documentation has started in 2008/09, has constantly been reduced, whereas the incidence in Germany has surpassed the Netherlands´ in 2022/23
Fig. 3
Fig. 3
Total number of children and adolescents with firework induced eye injuries in the Netherlands and in Germany. Since 2008/09 in the Netherlands, the number of injured children under 12 years was lower than the adolescents´. In Germany in all years more children under 12 years were injured than adolescents in all years since 2016/17
Fig. 4
Fig. 4
Total number of bystanders with firework induced eye injuries in the Netherlands and in Germany. The number of bystanders was decreased in the Netherlands over all years of documentation. In Germany the number of bystanders or persons, who were injured in an unclear situation was increasing over time of documentation and accounted for roughly half of all fire work induced eye injuries. If patients were added who `were injured in an unclear situation´ this rate increased up to 66%. This answer option was available in Germany only
Fig. 5
Fig. 5
10 years old girl who was hit by a rocket as a bystander. She suffered from an upper lid injury and a severe blunt eye trauma with choroidal rupture. Resulting Snellen visual acuity was 0,1 in the right eye
Fig. 6
Fig. 6
Enucleated globe of a bystander, who sustained a severe blunt trauma with total loss of iris and lens into the vitreous by an unknown consumer firework on New Year´s Eve 2022/23. Recurrent retinal detachments due to proliferative vitreoretinopathy (PVR) and a painful secondary glaucoma led to the total loss of vision and an enucleation within 6 months from the incident
See this image and copyright information in PMC

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