Eye injuries from fireworks used during celebrations and associated vision loss: the international globe and adnexal trauma epidemiology study (IGATES)

Geographical differences in ophthalmic trauma outcomes and risk factors: the International Globe and Adnexal Trauma Epidemiological Eye Study (IGATES)

OBJECTIVES

Characterise the international variation in ophthalmic trauma and determine risk factors associated with visual and anatomical outcomes for low-, middle- and high-income countries.

SUBJECTS/METHODS

Observational multi-centre cohort study using data from the International Globe and Adnexal Trauma Epidemiological Eye Study (IGATES) from April 2014 to August 2023. Data on acute presentations of ophthalmic injury including open/closed globe injury, and/or Adnexal/orbital involvement, and/or intraocular/ intraorbital foreign body were collected and Ocular Trauma Score (OTS) was calculated. A total of 5350 patients (5557 eyes) from 31 centres in 12 countries were included. The main outcome measures included demographics, mechanism and setting of injury, and presenting and final visual outcomes. Descriptive statistics, Kruskal-Wallis tests and multinomial logistic regression (MLR) analysis are presented, with correction performed using the Hochberg method. P values less than 0.005 were significant.

RESULTS

Age, gender, presenting and final best-corrected visual acuity were all strongly associated with country (p < 0.005). Poor final visual outcomes were strongly associated with OTS predictions, type of injury (p < 0.005) and delayed presentation as well as firework injuries. High-income countries (HIC) showing reduced duration to presentation (HIC 5 h) and increased improvement in visual acuity (HIC -0.40) compared to low to middle-income countries (LMICs) (28 h) (-0.19). MLR analysis identified a significant association between countries' income classification and BCVA worse than 6/60, presence of scleral, iris, limbus injury and surgery being undertaken (p < 0.005).

CONCLUSION

Data from 31 centres internationally identified differences in demographic trends for each country. Age was identified as a risk factor for eye injuries. Low- and middle-income countries were associated with longer delays to presentation, smaller gains in BCVA and poorer visual outcomes. IGATES provides an opportunity to collect global data on ophthalmic trauma to facilitate improved management and prevention strategies.

A Retrospective Case Review of Firework-Related Ocular Injuries in Malaysia

BACKGROUND

Fireworks are known to cause severe ocular injuries. This study was intended to examine the pattern and visual outcomes of firework-related severe eye injuries in Malaysia.  Methods: A retrospective review of fireworks-related eye injuries was conducted in Malaysia from 1st July 2022 to 30th June 2023. The data were collected from the ophthalmologists who treated and managed those cases. An open invitation was sent to the members of an ophthalmological society requesting case reports of severe ocular injuries requiring admission for further management.

RESULTS

A total of 24 eyes were severely injured due to fireworks. Injuries were mostly among males, accounting for up to 66.67% (n=16), and children under 12 years old (33.33% (n=8)). Among the patients who were admitted due to severe fireworks ocular injuries, 58.33% (n=14) of them had open globe injuries followed by closed globe injuries (41.67% (n=10)), and eyelid injuries (41.67% (n=10)). Following firework eye injuries, at least 41.67% (n=10) of the eyes were blinded.

CONCLUSION

This study revealed severe eye injuries due to fireworks, ending in blindness in over one-third of the cases, and children were particularly vulnerable. Sight loss due to fireworks can be prevented through strong government policy, public awareness, and timely management.

Globe trauma associated with falls at Australian tertiary centres

OBJECTIVE

Falls frequently cause globe and adnexal trauma, particularly in the elderly. The morbidity decreases confidence, independence and quality of life. We aimed to improve the understanding of fall-related globe and adnexal trauma and the involvement of ophthalmology at two tertiary trauma centres.

METHODS

A retrospective medical record review was conducted at Royal North Shore Hospital and Royal Prince Alfred Hospital of patients admitted with fall-related globe and/or adnexal trauma between January 2015 and December 2019. International Classification of Disease Tenth Revision codes were used to identify patients for inclusion. Medical records were reviewed to extract data on demographics, trauma, ocular examination and referrals to ophthalmology.

RESULTS

From January 2015 to December 2019, 346 patients, 186 were female (54%) and median age 76 years (interquartile range 24 years), were admitted to Royal North Shore Hospital and Royal Prince Alfred Hospital with fall-related globe and/or adnexal trauma. One hundred and twenty-five (36%) suffered globe trauma with 48 (14%) classified as severe. Patients over 65 years old had at least three risk factors contributing to falls. Alcohol and illicit substances were involved in 20% of falls and occurred predominantly in younger populations. There were significantly more patients with globe trauma if orbital/mid-facial fractures were present (55% vs 36%, P < 0.001).

CONCLUSION

Fall-related globe and adnexal trauma were more common in the elderly. Alcohol and illicit substances have a role in falls in younger populations. Thorough ocular assessment is required especially in mid-facial/orbital trauma to exclude globe trauma. Further, research is required to determine the effect of fall prevention strategies in preventing globe trauma.

Local Firework Restrictions and Ocular Trauma

Importance

Fireworks can cause vision-threatening injuries, but the association of local legislation with the mitigation of these injuries is unclear.

Objective

To evaluate the odds of firework-related ocular trauma among residents of areas where fireworks are permitted vs banned.

Design, Setting, and Participants

This case-control study was conducted at a level 1 trauma center in Seattle, Washington, among 230 patients presenting with ocular trauma in the 2 weeks surrounding the Independence Day holiday, spanning June 28 to July 11, over an 8-year period (2016-2022).

Exposures

Firework ban status of patient residence.

Main Outcomes and Measures

Odds of firework-related injuries among residents of areas where fireworks are legal vs where they are banned, calculated as odds ratios (ORs) and 95% CIs.

Results

Of 230 consultations for ocular trauma during the study period, 94 patients (mean [SD] age, 25 [14] years; 86 male patients [92%]) sustained firework-related injuries, and 136 (mean [SD] age, 43 [23] years; 104 male patients [77%]) sustained non-firework-related injuries. The odds of firework-related ocular trauma were higher among those living in an area where fireworks were legal compared with those living in an area where fireworks were banned (OR, 2.0 [95% CI, 1.2-3.5]; P = .01). In addition, the odds of firework injuries were higher for patients younger than 18 years (OR, 3.1 [95% CI, 1.7-5.8]; P < .001) and for male patients (OR, 3.3 [95% CI, 1.5-7.1]; P = .004). Firework injuries were more likely to be vision threatening (54 of 94 [57%]) compared with non-firework-related injuries (54 of 136 [40%]; OR, 2.1 [95% CI, 1.2-3.5]; P = .01).

Conclusions and Relevance

This case-control study suggests that the odds of firework-related ocular trauma were slightly higher among residents of areas where fireworks were legal compared with residents of areas where fireworks were banned. Although these results suggest that local firework bans may be associated with a small reduction in the odds of firework-related ocular trauma, additional studies are warranted to assess what actions might lead to greater reductions.

Globe and adnexal trauma at Australian trauma centres

INTRODUCTION

In multisystem trauma, the assessment and management of globe and adnexal trauma is often complex. Ophthalmology input may assist managing such patients. To understand the role of ophthalmology in tertiary trauma centres we report on the management of globe and adnexal trauma at two tertiary trauma centres in Sydney, Australia.

METHOD

A retrospective case series was completed at Royal North Shore Hospital (RNSH) and Royal Prince Alfred Hospital (RPAH) on patients admitted between January 2015 and December 2019. International Classification of Disease, Tenth Revision codes, diagnostic and procedural coding data were used to identify patients admitted with globe and/or adnexal trauma. Data extracted from medical records included demographics, mechanism of injury, ocular examination and specialist ophthalmic referral.

RESULTS

Over 5-years, 773 patients, average age of 53.2years and 62% male, were admitted to RNSH and RPAH with globe and/or adnexal trauma. Most patients (83%) first presented to RNSH or RPAH. The most common mechanism of injury was falls (45%) followed by burns (13%). Two-hundred and thirty-five patients had multisystem trauma, of these patients, 121 (51%) suffered globe trauma with 49 (21%) classified as severe. Three patients were not diagnosed initially due to delayed ophthalmology referral.

CONCLUSION

Falls followed by burns were common causes of globe and adnexal trauma in Sydney, Australia. The presence of orbital/mid-facial injury may indicate a patient has globe trauma. In multisystem trauma, globe trauma may be diagnosed late or not identified. Ophthalmology review has an important role in diagnosing and managing globe trauma in multisystem trauma.

TFOS lifestyle: Impact of societal challenges on the ocular surface

Societal factors associated with ocular surface diseases were mapped using a framework to characterize the relationship between the individual, their health and environment. The impact of the COVID-19 pandemic and mitigating factors on ocular surface diseases were considered in a systematic review. Age and sex effects were generally well-characterized for inflammatory, infectious, autoimmune and trauma-related conditions. Sex and gender, through biological, socio-economic, and cultural factors impact the prevalence and severity of disease, access to, and use of, care. Genetic factors, race, smoking and co-morbidities are generally well characterized, with interdependencies with geographical, employment and socioeconomic factors. Living and working conditions include employment, education, water and sanitation, poverty and socioeconomic class. Employment type and hobbies are associated with eye trauma and burns. Regional, global socio-economic, cultural and environmental conditions, include remoteness, geography, seasonality, availability of and access to services. Violence associated with war, acid attacks and domestic violence are associated with traumatic injuries. The impacts of conflict, pandemic and climate are exacerbated by decreased food security, access to health services and workers. Digital technology can impact diseases through physical and mental health effects and access to health information and services. The COVID-19 pandemic and related mitigating strategies are mostly associated with an increased risk of developing new or worsening existing ocular surface diseases. Societal factors impact the type and severity of ocular surface diseases, although there is considerable interdependence between factors. The overlay of the digital environment, natural disasters, conflict and the pandemic have modified access to services in some regions.

[Pandemic-related sales ban of fireworks in Germany leads to a significant reduction of firework-related eye injuries]

BACKGROUND AND AIM

The continuous recording of eye injuries caused by fireworks around New Year's Eve over 6 years allows us to investigate injury numbers, injury patterns, and accident histories in a year to year comparison. In order to relieve the burden on hospitals during the COVID-19 pandemic, a ban on the sale of firework articles was implemented in Germany for 2020/2021 and 2021/2022. We investigate the impact of these measures on the number of fireworks-related eye injuries and analyze whether this led to an increase in serious injuries and an association with increased use of homemade pyrotechnics or pyrotechnics potentially not approved in Germany.

METHODS

We used our online questionnaire to collect anonymized data on patients, accident history, and, since 2017/2018 information on the acquisition of firework articles.

RESULTS

Our analysis included data from 2151 affected individuals. While data of about 500 injured were entered per year before the pandemic, this number decreased to 79 in 2020/2021 and 193 in 2021/2022. The proportion of severe eye injuries requiring inpatient care ranged from 21% to 26% in the years before the pandemic but ranged from 27% to 34% in the pandemic years. At the same time, under the sales ban the proportion of fireworks that were homemade or unofficially purchased increased from 3% to nearly 10%. In terms of absolute numbers, however, there were 67 accidents involving unofficially purchased pyrotechnics compared with 1675 incidents involving officially purchased or unidentified fireworks, which can be explained by the high proportion (about 50%) of injured bystanders.

CONCLUSION

The absolute number of patients with eye injuries caused by pyrotechnics decreased under the pandemic conditions from about 500 to 79 or 193. The use of fireworks designated as unofficially purchased was proportionally low even under the sales ban, and plays a minor role compared to injuries with officially purchased fireworks articles.