The Persian Wednesday Eve Festival “Charshanbe-Soori” Fireworks Eye Injuries: A Case Series

Firework-Related Ocular Trauma at a Level 1 Trauma Center During a City-Wide Pandemic Lockdown: A Case Series

Purpose To report six ocular injury cases caused by unlicensed fireworks and subsequent complications at a level 1 trauma center in the setting of coronavirus disease 2019 (COVID-19)-related shelter-in-place orders. Observations All six cases occurred between March 2020 and July 2020 and involved fireworks of non-official use. A majority of subjects were male between the ages of 17 and 53 years old. Ocular trauma presented as the following: Case 1 is a 17-year-old male who sustained a left-sided corneal abrasion and small intraocular foreign body after a firework exploded in his hand. Case 2 is a 47-year-old male who presented with a right globe rupture after being struck with a projectile from a neighborhood fireworks display. Case 3 is a 36-year-old male with corneal abrasion, traumatic iritis, and commotio retinae after a firework injury in the setting of alcohol use. Case 4 is a 35-year-old male who presented with left lid injury, corneal abrasion, and hyphema after being struck by a firework with evidence of penetrating eye trauma on subsequent exams. Case 5 is a 53-year-old male who developed bilateral subconjunctival hemorrhages and a partial-thickness corneal laceration after a firework exploded in his left hand. Case 6 is a 48-year-old woman who sustained bilateral corneal stromal foreign bodies while cooking after a firework exploded near her vicinity. Conclusions and importance Fireworks are a preventable cause of mortality and long-term ocular morbidity. The index of suspicion for open globe injuries related to fireworks should be high given the mechanism of injury. These presenting cases at a level 1 trauma center and safety net hospital may be an unforeseen by-product of COVID-19 lockdowns. Our findings are relevant to trauma centers and safety net hospitals with large cases of firework injuries. Further initiatives to improve awareness of the dangers of fireworks should be prioritized to limit harms for all community members.

Pediatric Open Globe Injuries Caused by Firecrackers in a Tertiary Eye Care Hospital in Iran

OBJECTIVE

The aim of the study is to determine characteristic features of open globe injuries caused by firecrackers among pediatric population.

METHODS

In this retrospective cross-sectional chart review, medical records of children with ocular trauma who were hospitalized in Isfahan, Iran, during 2013-2017 were reviewed. We analyzed the collected data before and after propensity score (PS) matching.

RESULTS

Of 396 pediatric patients with open globe injury, 22 injuries (5.9%) were caused by firecrackers. Hyphema, iris prolapse, and lens rupture were noted in 15 (68.18%), 10 (45.45%), and 2 (9.09) eyes, respectively. None of patients had endophthalmitis. The mean age of patients in firecracker group was higher and significant (11.86 ± 4.05 in firecracker vs 7.80 ± 4.68 in nonfirecracker, P < 0.001). Furthermore, most boys were in firecracker group (95.5%, P = 0.005). Patients in firecracker group resided more in urban areas (86.4%, P = 0.054) and had more intraocular foreign body (IOFB) in the eyes (40.9%, P < 0.001). After PS matching, patients in firecracker group had higher IOFB ( P = 0.008). In logistic regression models, patients with corneal lacerations had lower odds for long-time admission (≥4 days) than patients with both corneal and scleral lacerations in crude model (odds ratio, 0.35; 95% confidence interval, 0.17-0.69) and adjusted model (odds ratio, 0.37; 95% CI, 0.18 to 0.74). After PS matching, there was no significant association between risk factors and outcomes.

CONCLUSIONS

The present study showed several differences between the pediatric open globe injuries caused by firecrackers and other mechanisms of injuries, including the age, sex, living place, presence of IOFB, and length of hospital stay.

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

Background

Firework-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.

Methods

This 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.

Results

A 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.

Conclusion

This study provides the first data on FWROI in Switzerland, which are helpful for further preventive and educational programs and comparisons with other countries.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12886-022-02513-9.

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.

Profile and Management Outcomes of Fireworks-Related Eye Injuries in Saudi Arabia: A 16-Year Retrospective Study

BACKGROUND

Fireworks are a culturally significant part of celebrations in many parts of the world but can lead to blinding injuries.

OBJECTIVE

To decipher the profile and management outcomes of fireworks-related eye injuries at a tertiary eye hospital in central Saudi Arabia.

METHODS

This was a retrospective review of cases with fireworks-related eye injuries managed at our institution between 2003 and 2019. Demographic information, clinical features at presentation, mode of management, and visual outcome were evaluated at the last follow-up.

RESULTS

A total of 155 eyes of 150 patients with a median age of 10 years [127 male (84.7%) and 69 (46%) right eyes, 76 (50.7%) left eyes, and 5 patients with bilateral injury] were enrolled for the study. Among the injured individuals, 59 (39.3%) were bystanders and 91 (60.7%) had ignited the fireworks. The fireworks included bangers (53; 35.3%), rockets in bottle (42; 28%), firecrackers (41; 27.3%). Closed globe injury (CGI) was the most common type of eye injury (100; 64.5% eyes) while Open globe injury (OGI) was noted in (55; 35.5% eyes). Management used for treatment included penetrating injury repair (55; 35.5%), lens removal/lens implant (51; 32.9%). Corrected distance visual acuity obtained after 6 months was 20/20 to 20/60 (74; 47.7%), 20/70 to 20/200 in (31; 20%), <20/200 to 20/400 in (9; 5.8%) and <20/400 in (41; 26.5%) eyes. Treatment was able to restore vision and salvage blindness in 50 (32.3%) eyes.

CONCLUSION

Mainly males were found to suffer from fireworks-related eye injuries and the main fireworks responsible for them were bangers. Visual disability remained in one-third of the treated patients.

Penetrating intracranial injury caused by an unusual home-made iron pyrotechnic device

Herein, a potentially dangerous explosive home-made device used for fun and entertainment is described. It consists of two iron parts connected with a U-shaped thick wire: a wedge about 8 cm in length, which fits into a hollow cylinder, filled with a small amount of nitre (the mineral form of potassium nitrate). Striking the device onto a hard surface creates a spark inside it, which burns the nitre, producing a very loud bang. We are in possession of such device in our forensic museum collection. We present a case from 1937 related to the use of this explosive home-made device. A boy was injured using it, as the wedge hit him in the left temporal region and entered his skull. The major initial consequence was a localised brain injury, without any bleeding. Delayed presentation resulted in intracranial infection - purulent meningitis due to open craniocerebral injury, which was the cause of death three months later. The potentially dangerous home-made explosive iron device presented here was in use mostly by children from the end of the 19th century until the early 1970s, when it was replaced with less dangerous and cheaper Chinese firecrackers and fireworks.

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.

Missed Diagnosis of an Intraorbital Foreign Body of Homemade Fireworks Origin: A Case Report

Purpose

We report a rare case of traumatic injury to the eye caused by homemade fireworks in a Chinese juvenile patient with a metal ring left in the orbit after having been sutured at the Emergency Department.

Methods

An 11-year-old boy presented with a traumatic injury to the right eye from homemade fireworks. Following initial assessment involving maxillofacial computed tomography (CT) and suturing at the Emergency Department, he was transferred to our department for further evaluation because of his poor sight 1 day later. On examination, a skin laceration beneath the right eyebrow was noted, but the superior orbit was not fully visible on the maxillofacial CT performed 1 day previously. Therefore, an orbital CT scan was carried out on the second day, which showed a hyperdense ring embedded in the superior border of the orbital wall; the ring was surgically removed. On postoperative day 7, a fundus examination revealed resolving vitreous hemorrhage, blunt traumatic retinal detachment, and a large retinal tear superior to the macula. The patient refused to take surgery for retinal detachment into consideration. Therefore, we opted for oral steroids and careful observation.

Results

After 2 months’ observation, the large retinal tear had healed and white fibrous scar tissue had developed, and the retinal detachment superior to the macula had reattached itself spontaneously. The patient's vision had further improved to 20/200. During 1 year of follow-up, he remained clinically stable.

Conclusion

To avoid missing the diagnosis, a complete history of the mechanism of injury and accurate imaging still prove most useful. Complete removal of the foreign body by the emergency physician is necessary because of the ocular toxicity of an iron-containing foreign body. As evidenced by the current case, oral steroids and observation for a period of several months is a management of choice for traumatic retinal detachment and retinal tear superior to the macula associated with homemade fireworks in children.

Crash and Burn: Ocular Injuries due to Fireworks

PURPOSE

To identify the patterns of ocular injury and to determine ocular morbidity resulting from the use of firecrackers.

METHODS

A prospective observational study of all patients presenting with ocular trauma consequent to fireworks usage in a tertiary eye care center in South India over a one-month period around the autumn festival of Diwali. We also reviewed the published literature from around the world reporting ocular injuries due to firecrackers.

RESULT

49 patients were included in the study, out of which the vast majority (40/81%) were males. The mean age was 17 years. Almost an equal number of bystanders (24/48.9%) was affected as compared to people handling the fireworks (25/51%). 13 (26.53%) patients had open-globe injury whereas 33 (67.34%) patients had closed-globe injury. Twenty-two (44.8%) patients underwent surgical intervention. Eighteen (36.7%) patients had final vision less then 20/40 (range = 20/50 to No Perception of Light) with eight patients having no perception of light in the affected eye.

CONCLUSION

Unregulated use of firecrackers can lead to significant ocular morbidity, mainly involving children, young males, and even innocent bystanders. A combination of public awareness and appropriate legislative laws should be formulated regarding the use of fireworks to decrease the load of needless blindness on society.

Firecracker injuries during chaharshanbeh soori festival in iran: a case series study

On the last Wednesday of every year Iranians celebrate the sanctity of fire in the annual festival of Chaharshanbeh Soori. Each year many cases of firecracker-related injuries (FRI) are reported during this festival. The aim of this study was to assess the pattern of injuries and the frequency of disabilities during this period. In 2011, a cross-sectional study was conducted at the emergency departments (EDs) of three educational hospitals in Tehran, to assess the extent and demographics of FRI. The age and sex of the patient, type of referral to the hospital, type of injury, its region and treatment process were recorded for each patient by the physicians. Data were analyzed by SPSS version 20. Thirty-five patients suffering from FRI were admitted to the hospitals during the festival. The majority of patients were under 30 years-old and most of them were male (83% male and 17% female). The injuries were mostly lacerations and cuts (n = 17, 49%) and scratches (n = 12, 34%). One patient suffered amputation. The most common site of the injuries were the hands (n = 13, 37%) followed by the face (n = 10, 29%). There were 10 patients (29%) with more than one site of injury. Twenty-one patients were hospitalized, 12 patients (34%) received outpatient treatment and two patients were referred to other hospitals. There are still many victims during Chaharshanbeh Soori festival despite efforts and legislations by the government. Education and raise of awareness among people especially for youth are the most important ways to prevent and reduce Red Wednesday injuries.

Mortality and morbidity of fireworks-related burns on the annual last wednesday of the year festival (charshanbeh soori) in iran: an 11-year study

BACKGROUND

Management of firework-related injuries is costly for the patient, society, and government.

OBJECTIVES

Evaluating effective factors yielding to such injuries may lead to better management of patients and decreased costs and morbidities.

PATIENTS AND MATERIALS

This retrospective cross-sectional study was performed on burn patients referred to Shahid Motahari Burns Hospital on Charshanbeh Soori day festival during the period extending from March 2000 to March 2011 (11 days in an 11-year period). Demographic data, causes of burn injury, severity, and affected body parts were recorded. Data were analyzed using SPSS version 16.

RESULTS

There were164 patients in the study with a mean age of 18.34 ± 9.31 years; 87% (145/164) were male. Homemade grenades were the most frequent cause of injury. Hand injury was reported in 56% (92/164) of the cases. Amputation was executed in 7 (4.3%) cases, and 6 (3.7%) patients died due to severe burn injuries and facial damage.

CONCLUSIONS

Fireworks- related injuries during Charshanbeh Soori ceremony causes significant morbidities and damage to different body parts (especially upper limbs and face), and some of these injuries will lead to life time disabilities, amputations, and even death. As most of the injured patients are young teenagers and children, special consideration must be taken into account to prevent long term morbidities.

Different causes of referral to ophthalmology emergency room

Background:

Eye-related complaints compose approximately 1–6% of complaints of patients referring to general emergency ward around the world. Eye injuries are the most common cause of referral to eye emergency ward. To understand the impact of eye injuries in Iran and to plan preventive strategies, it is important to understand the complete magnitude of the problem with regard to true population-based data and standard reproducible definitions.

Aim:

The main goal of this study was to identify the major causes of referrals to eye emergency ward in patients with eye-related complaints in an eye referral Hospital in Iran.

Settings and Design:

In a cross-sectional study, 3150 patients who referred to Farabi Hospital emergency ward, Tehran, Iran, from January to December 2007 were included in the study and their detailed information were recorded.

Materials and Methods:

The patients’ demographic data, medical history and final diagnosis were recorded in a questionnaire.

Results:

The mean age of patients was 33.2±16.8 years and 2380 patients (75.6%) were males. While 299 patients (9.5%) were referred for non-urgent reasons, work-related injuries were the most common cause of referral (955 patients; 30.3%). In patients referred due to trauma (1950 patients), work-related injuries occurred in 955 patients (49%) and occurred accidentally (by chance) in 819 patients (42%). The majority of patients referred with traumatic injuries were males (1708 patients; 87.6% versus 242 patients; 12.4%). The most common etiologies of eye trauma (1950 patients) were metal filings (814 patients; 41.8%), blunt trauma (338 patients; 17.3%), fireworks (236 patients; 12.1%) and sharp objects (222 patients; 11.4%). Globe injury was diagnosed in 1865 patients (95.7%) of trauma cases. In patients referred due to non-traumatic reason (1200 patients), eye infection occurred in 482 patients (40.2%) and 299 patients (24.9%) were referred for non-urgent reasons. There was little difference between the frequency of non-trauma-related problems among genders (672 male patients; 56% versus 528 female patients; 44%).

Conclusions:

This study identified multiple risk factors whose presence significantly increases severity of an eye injury. Male gender, youth and unprotected eyes during high-risk activities such as sports and certain jobs are risk factors for eye injuries. In patients referred due to non-traumatic reasons, males and females are similar. Considerable proportion of non-trauma-related problems was due to eye infection, that one of the most important reasons may be connected to the increasing use of contact lenses in our target population. Thereupon, we need for further educative and preventive interventions at the level of general population.

Clinical and epidemiologic characteristics of severe childhood ocular injuries in southern iran

Purpose:

To evaluate the clinical and epidemiological characteristics of children with ocular trauma.

Materials and Methods:

We retrospectively reviewed the medical records of 278 children (aged 15 years or less) hospitalized with ocular injuries and treated as inpatients at a tertiary referral center in Shiraz, Iran, from 2005 to 2008. Nominal variables were evaluated with a Chi-square test. A P-value less than 0.05 indicated statistical significance.

Results:

The cohort was comprised of 205 (74%) males, outnumbering females by a ratio of 2.81/1. The mean age was 7.6 ± 3.96 years. Rural residents comprised 125 (45%) of the cohort. Sharp objects caused ocular injury in 211 (76%) cases, and 207 (74%) cases had open-globe injuries. The lens was injured in 62 (30%) cases at initial examination and 89 (43%) patients according to ultrasound examination (P = 0.006). Twenty-eight cases (10%) developed post-traumatic endophthalmitis. Endophthalmitis was associated with needle injury [odd ratio (OR) = 19.25] and presence of intraocular foreign body (OR = 3.48). Visual acuity of patients with closed-globe injuries was 20/200 or better on both initial and final examinations. Visual acuity of patients with open-globe injuries were in the range of light perception to 20/200.

Conclusions:

Trauma is an important cause of childhood ocular morbidity in southern Iran. Playing with sharp objects is an important cause of ocular trauma in children, and most injuries can be prevented by careful supervision.

Ultrasound biomicroscopy findings in fireworks-related blunt eye injuries

PURPOSE

To present ultrasound biomicroscopic (UBM) findings and their clinical correlations in people with optically hazy media after injury at the Persian Wednesday Eve fireworks festival.

METHODS

Ultrasound biomicroscopy was performed on a series of 32 eyes with severe closed-globe injuries by P40 ultrasound biomicroscope.

RESULTS

The median age of the participants was 19 years, and 81.3% were male. All but one had gross hyphema. Seventy-five percent had an extension of the injury (at least) to Birmingham Eye Trauma Terminology zone II. Ultrasound biomicroscopy detected 3 more iridodialyses and 10 more cyclodialyses in addition to the respective 5 and 3 that were diagnosed clinically. Ten cases of angle recession were observed, and 5 were suggestive of subluxation of the crystalline lens. Two cases were suspected for anterior segment intraocular foreign body on clinical examination, but UBM and computed tomography scanning together ruled out such a diagnosis.

CONCLUSIONS

Our study showed the value of UBM in the assessment of severely contused eyes and hyphema. It made possible evaluation for dialyses and recessions at presentation. Ultrasound biomicroscopy illustrated diverse subclinical disruptions in clinically invisible anterior segment structures.

The health and economic impact of fireworks-related injuries in Iran: a household survey following the New Year's Festival in Tehran

INTRODUCTION

Fireworks are used worldwide as a part of national and cultural celebrations. Personal use of fireworks is associated with serious injuries. The "Last Wednesday Eve Festival" is celebrated on the evening before the last wednesday of the Persian calendar year. In recent years, fireworks have been widely used during the festival, which has resulted in injuries. The aim of this study was to determine the incidence and risk factors of fireworks-related injuries associated with the Last Wednesday Eve Festival, in Tehran, Iran.

METHODS

A household survey of residents of greater Tehran, using a random cluster sampling design was performed. Number of fireworks-related injuries, expenditures for fireworks and medical treatment of fireworks-related injuries, length of hospital stay for treatment of these injuries and the personal property damage was gathered.

RESULTS

Interviews were conducted of 2475 households in greater Tehran. At least one member of 19.8% of these households had used fireworks during the 2007 Last Wednesday Eve Festival. Fireworks-related injuries were more common among households whose members had used homemade fireworks than among households whose members had used only commercially made fireworks (OR=16.5, 95% CI: 5.7-47.5). Forty-five households reported that they had sustained personal property damage caused by fireworks during the festival, costing a mean of US$ 36.60. Households with at least one injured member spent a mean of US$ 441.90 for medical care and a mean of US$ 70.80 for other expenses related to seeking medical care. The overall incidence of fireworks-related injury among household members was 0.2% (95% CI: 0.1-0.3%). Fireworks-related injury incidence was highest in the 10-19 age group. The total estimated number of fireworks-related injuries in Tehran during the 2007 Last Wednesday Eve Festival was approximately 17,000. Among the 20 injured individuals, 4 persons (20.0%) were hospitalised for a mean of 2.8 days.

CONCLUSIONS

The personal use of fireworks in Iran is associated with serious injuries and non-trivial economic costs. This study is the first to describe the incidence and economic costs of fireworks-related injuries in a major city in Iran using a population-based survey. To prevent these injuries, individuals should attend public fireworks displays conducted by professionals rather than engage in personal use of fireworks.

Firecracker eye injuries during Deepavali festival: a case series

We report a large series of ocular injuries caused by fire-crackers. This study was a hospital-based, singlecenter, retrospective case series in which the records of 51 patients with ocular injuries were analyzed. Injuries were classified according to Birmingham eye trauma terminology system (BETTS). Visual outcomes before and after the intervention were recorded. Ten patients were admitted for further management. As ocular firecracker injuries result in significant morbidity, public education regarding proper use of firecrackers may help in reducing the incidence of ocular injuries.