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Harrison L, Yee P, Sundararajan M, Ding L, Feng S. Local Firework Restrictions and Ocular Trauma. JAMA Ophthalmol 2024; 142:33-38. [PMID: 38095891 PMCID: PMC10722385 DOI: 10.1001/jamaophthalmol.2023.5698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 10/18/2023] [Indexed: 12/17/2023]
Abstract
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.
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Affiliation(s)
- Luke Harrison
- Department of Ophthalmology, University of Washington School of Medicine, Seattle
| | - Philina Yee
- Department of Ophthalmology, University of Washington School of Medicine, Seattle
| | - Miel Sundararajan
- Department of Ophthalmology, University of Washington School of Medicine, Seattle
| | - Leona Ding
- Department of Ophthalmology, University of Washington School of Medicine, Seattle
| | - Shu Feng
- Department of Ophthalmology, University of Washington School of Medicine, Seattle
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Winicki NM, Waldrop I, Orozco JV, Novak D, Sheets NW. The epidemiology of firework-related injuries in the US, 2012-2022. Inj Epidemiol 2023; 10:32. [PMID: 37403127 DOI: 10.1186/s40621-023-00446-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 06/27/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND This study aimed to examine the epidemiology of firework-related injuries within a national population between 2012 and 2022, including the severity of injury by year, patient demographics, body region injured, firework type, and diagnosis category of injury. METHODS Data were collected from the Consumer Product Safety Commission's National Electronic Injury Surveillance System, which is a representative nationwide database that collects data on consumer product-related injuries occurring in the US. Injury rates were calculated based on patient age, sex, body region injured, firework type, and diagnosis category. RESULTS A total of 3219 injuries, representing an estimated 122,912 firework-related injuries, were treated in emergency departments within the US from 2012 to 2022. The overall incidence rate of firework-related injuries in the study rose by over 17% from 2012 [2.61 cases per 100,000 people (95% CI 2.03-3.20)] to 2022 and [3.05 cases per 100,000 people (95% CI 2.29-3.80)]. The rate of injuries was highest in adolescents and young adults (age 20-24; 7.13 cases per 100,000 people). Men experienced firework injuries at more than double the rate of women (4.90 versus 2.25 cases per 100,000 people). The upper extremities (41.62%), head/neck (36.40%), and lower extremities (13.78%) were the most commonly injured regions. Over 20% of cases in patients older than 20 were significant injuries requiring hospitalization. Aerial devices (32.11%) and illegal fireworks (21.05%) caused the highest rates of significant injury of any firework type. CONCLUSIONS The incidence of firework-related injuries has risen over the past decade. Injuries remain the most common among adolescents and young adults. In addition, significant injuries requiring hospitalization occur most often during aerial and illegal firework use. Further targeted sale restrictions, distribution, and manufacturing regulations for high-risk fireworks are required to reduce the incidence of significant injury.
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Affiliation(s)
- Nolan M Winicki
- School of Medicine, University of California Riverside, 900 University Ave, Riverside, CA, 92521, USA.
| | - Ian Waldrop
- School of Medicine, University of California Riverside, 900 University Ave, Riverside, CA, 92521, USA
| | - Jesus V Orozco
- School of Medicine, University of California Riverside, 900 University Ave, Riverside, CA, 92521, USA
| | - Daniel Novak
- School of Medicine, University of California Riverside, 900 University Ave, Riverside, CA, 92521, USA
| | - Nicholas W Sheets
- School of Medicine, University of California Riverside, 900 University Ave, Riverside, CA, 92521, USA
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Werz J, Greve J, Hoffmann TK, Hahn J. New Year's Eve in otorhinolaryngology: a 16-year retrospective evaluation. Eur Arch Otorhinolaryngol 2023; 280:3453-3459. [PMID: 37062783 PMCID: PMC10106316 DOI: 10.1007/s00405-023-07966-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 04/04/2023] [Indexed: 04/18/2023]
Abstract
PURPOSE Pyrotechnics are a long-standing tradition at the turn of the year. There are little data available on New Year's Eve-associated ORL injuries. Due to restrictions during the Corona pandemic, the handling of fireworks and meetings on New Year's Eve 2020-2022 had been significantly changed. Our aim was to analyze first data about New Year's Eve-associated ORL injuries. METHODS A retrospective analysis of 16 turns of the year (2006-2022) at a University ORL department was performed. The 2 recent years were influenced by the changes and restrictions of the COVID-19 pandemic. RESULTS Of 343 emergency presentations, 69 presented with New Year's Eve-associated reasons (20%). 72% were male, 15.9% were underage. 74% presented for fireworks-related injuries, 19% due to violent altercations. Noise trauma was present in 71%. The average number of New Year's Eve-associated emergency patients per year and the average total number of patients were reduced by more than half under COVID-19 pandemic conditions. CONCLUSIONS New Year's Eve-associated ORL injuries range from inner ear trauma to midface fractures. Long-term damage may include hearing loss and tinnitus. These results shall support the responsible use of fireworks even after the end of the special regulations of the COVID-19 pandemic.
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Affiliation(s)
- Julia Werz
- Division of Phoniatrics and Paediatric Audiology, Waldstr. 1, Erlangen, Germany
| | - Jens Greve
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Ulm, Frauensteige 12, 89075, Ulm, Germany
| | - Thomas K Hoffmann
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Ulm, Frauensteige 12, 89075, Ulm, Germany
| | - Janina Hahn
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Ulm, Frauensteige 12, 89075, Ulm, Germany.
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Turgut F, Bograd A, Jeltsch B, Weber A, Schwarzer P, Ciotu IM, Amaral J, Menke MN, Thommen F, Tandogan T, Tappeiner C. Occurrence and outcome of firework-related ocular injuries in Switzerland: A descriptive retrospective study. BMC Ophthalmol 2022; 22:296. [PMID: 35799154 PMCID: PMC9260982 DOI: 10.1186/s12886-022-02513-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 06/29/2022] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Ferhat Turgut
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Ophthalmology, City Hospital Triemli, Zurich, Switzerland
| | - Alexandra Bograd
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Brida Jeltsch
- Department of Ophthalmology, University Hospital of Zurich, Zürich, Switzerland
| | - Adrian Weber
- Department of Ophthalmology, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Petra Schwarzer
- Department of Ophthalmology, Pallas Klinik Olten, Louis Giroud-Strasse 20, 4600, Olten, Switzerland
| | - Iulia M Ciotu
- Department of Ophthalmology, University Hospitals of Geneva, Geneva, Switzerland
| | - Joao Amaral
- Department of Ophthalmology, Kantonsspital Aarau, Aarau, Switzerland
| | - Marcel N Menke
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Ophthalmology, Kantonsspital Aarau, Aarau, Switzerland
| | - François Thommen
- Department of Ophthalmology, University of Lausanne, Hôpital Ophtalmique Jules-Gonin, Lausanne, Switzerland
| | - Tamer Tandogan
- Department of Ophthalmology, Pallas Klinik Olten, Louis Giroud-Strasse 20, 4600, Olten, Switzerland
| | - Christoph Tappeiner
- Department of Ophthalmology, Pallas Klinik Olten, Louis Giroud-Strasse 20, 4600, Olten, Switzerland. .,Department of Ophthalmology, University Hospital Essen, University Duisburg-Essen, Essen, Germany. .,University of Bern, Bern, Switzerland.
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AlGhadeer H, Khandekar R. Profile and Management Outcomes of Fireworks-Related Eye Injuries in Saudi Arabia: A 16-Year Retrospective Study. Clin Ophthalmol 2021; 15:4163-4168. [PMID: 34703202 PMCID: PMC8526513 DOI: 10.2147/opth.s333121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 09/15/2021] [Indexed: 12/05/2022] Open
Abstract
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.
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Affiliation(s)
- Huda AlGhadeer
- Department of Emergency, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Rajiv Khandekar
- Department of Research, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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Changing Trends in Firework-Related Eye Injuries in Southern China: A 5-Year Retrospective Study of 468 Cases. J Ophthalmol 2020; 2020:6194519. [PMID: 32832138 PMCID: PMC7428839 DOI: 10.1155/2020/6194519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 07/14/2020] [Indexed: 11/18/2022] Open
Abstract
Firework-related eye injury is a horrible medical problem and creates huge health and social burdens. Herein, we explored the changing trends and demographic and clinical features of firework-related eye injury, in an effort to inform strategies to prevent this injury. We reviewed the data of 468 hospitalized patients who underwent surgery for firework-related eye injury at the Zhongshan Ophthalmic Center between January 2013 and December 2017. During this period, the trend in firework-related eye injuries was stable (mean, 93 ± 14 cases per year), and fireworks were the major cause of explosive eye injury. The average age of the patients was 24 ± 18 years and 87% of the patients were male, with boys under 10 years of age comprising the largest group (27% of patients). There were an average of 24 ± 7 cases per year from urban areas and 70 ± 8 cases from rural areas (P < 0.05). Furthermore, 21 ± 5% of cases occurred during Spring Festival. After treatment, the best corrected visual acuity was increased compared to that before treatment, and the intraocular pressure tended to become normal by the final visit (P < 0.05). The top three diagnoses were cataract (39%), retinal detachment (18%), and choroidal detachment (14%). Additionally, the most common surgery was cataract extraction (25%), followed by pars plana vitrectomy (19%) and pars plana vitrectomy plus pars plana lensectomy (10%). Over the five-year study period, day surgery hospitalization increased from 1% to 32%. This was associated with a corresponding decrease in the length of hospitalization, without adverse events, demonstrating that day surgery is feasible in firework-related eye injury cases. The present study results suggest that greater attention should be paid to firework-related eye injury, and a variety of measures should be taken to prevent this kind of ocular tragedy.
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7
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Lenglinger MA, Zorn M, Pilger D, von Sonnleithner C, Rossel M, Salchow DJ, Bertelmann E. Firework-inflicted ocular trauma in children and adults in an urban German setting. Eur J Ophthalmol 2020; 31:709-715. [PMID: 31973551 PMCID: PMC8120635 DOI: 10.1177/1120672120902033] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To assess firework-inflicted ocular trauma in the German capital during the week around New Year's Eve with regards to patient characteristics and age, severity of injuries, and their management and outcome. METHODS A retrospective chart review of all patients presenting to the department of ophthalmology of Charité-University Medicine Berlin during a 7-day period around New Year's Eve in the years 2014-2017 was performed. Patients with ocular complaints and injuries caused by fireworks were included. We recorded demographic data, active role, visual acuity at presentation and at last follow-up, the most pertinent clinical findings, management and outcome with regards to visual acuity, and integrity of the eye. RESULTS A total of 146 patients with 165 injured eyes were included. Median age at presentation was 23 (4-58) years, and 71.2% were male. Fifty-one patients (34.9%) were less than 18 years old. Ninty-seven patients (66.4%) sustained minor, 34 (23.3%) sustained moderate, and 15 (10.3%) sustained severe injuries. Severe trauma was seen in younger patients (median age: 12, range: 4-58 years) than mild and moderate trauma (median age: 23, range: 4-45 years) and resulted in loss of light perception in two eyes and in a visual acuity of only light perception in three eyes. One eye was enucleated. CONCLUSION Ocular trauma inflicted by fireworks can have serious consequences for ocular morbidity and visual acuity, especially in severe trauma which affected younger patients. To significantly reduce firework-inflicted trauma, a ban of private fireworks in densely populated areas and in the vicinity of children should be considered.
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Affiliation(s)
| | - Malte Zorn
- Department of Ophthalmology, Charité-University Medicine Berlin, Berlin, Germany
| | - Daniel Pilger
- Department of Ophthalmology, Charité-University Medicine Berlin, Berlin, Germany
| | | | - Mirjam Rossel
- Department of Ophthalmology, Charité-University Medicine Berlin, Berlin, Germany
| | - Daniel J Salchow
- Department of Ophthalmology, Charité-University Medicine Berlin, Berlin, Germany
| | - Eckart Bertelmann
- Department of Ophthalmology, Charité-University Medicine Berlin, Berlin, Germany
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Diagnostik und Akuttherapie von Augenverletzungen durch Feuerwerkskörper. Ophthalmologe 2019; 116:1152-1161. [DOI: 10.1007/s00347-019-01000-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
Aim: The aim of this study is to determine the incidence and types of ocular injuries caused by fireworks in patients seen at Guinness Eye Centre Onitsha and their effects on vision. Methods: This was a 3-year retrospective study evaluating case files of patients with ocular fireworks injuries seen at Guinness Eye Centre Onitsha during the Christmas and New Year festivities (2010–2012). Information was extracted into a pro forma and analyzed using Excel, AutoSum, and calculators. Results: Subconjunctival hemorrhage, corneal lacerations, and hyphema were the most common injuries seen. Patients had multiple ocular pathologies, and the left eye was affected in 62.5% of cases. Bystanders accounted for 75% of those with ocular fireworks injuries. All were males. Half of the affected eyes went blind. Conclusion: Fireworks injuries constituted only 5.1%, 0%, and 10% of ocular injuries in 2010, 2011, and 2012, respectively, with devastating consequence of blindness in 50% of affected eyes.
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Affiliation(s)
| | - Cosmas C Anajekwu
- Department of Ophthalmology, Enugu State University of Science and Technology, Enugu, Nigeria
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Unterlauft JD, Rehak M, Wiedemann P, Meier P. Firework-Related Eye Trauma in Germany. Curr Eye Res 2018; 43:1522-1528. [PMID: 30110181 DOI: 10.1080/02713683.2018.1508725] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Jan Darius Unterlauft
- Department of Ophthalmology, Leipzig University Hospital, University of Leipzig, Leipzig, Germany
| | - Matus Rehak
- Department of Ophthalmology, Leipzig University Hospital, University of Leipzig, Leipzig, Germany
| | - Peter Wiedemann
- Department of Ophthalmology, Leipzig University Hospital, University of Leipzig, Leipzig, Germany
| | - Petra Meier
- Department of Ophthalmology, Leipzig University Hospital, University of Leipzig, Leipzig, Germany
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Pujari A, Kumar A, Chawla R, Khokhar S, Agarwal D, Gagrani M, Sharma N, Sharma P. Impact on the pattern of ocular injuries and awareness following a ban on firecrackers in New Delhi: A tertiary eye hospital-based study. Indian J Ophthalmol 2018; 66:837-840. [PMID: 29785995 PMCID: PMC5989509 DOI: 10.4103/ijo.ijo_1290_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose To review the nature of firecracker-related ocular injuries at a tertiary eye hospital in northern India following the firecracker ban and also to review the level of awareness among the victims. Methods A cross-sectional observational study involving the patients presenting with firecracker-related ocular injuries from October 18 to 27, 2017 were assessed for demographic distribution, detailed ocular evaluation, and a questionnaire related to the awareness about the injuries. Results A total of 68 patients were observed. Fifty patients (74.5%) were males. This year, a majority of patients were from outside Delhi. Uttar Pradesh constituted the most 38.23% of the patients followed by Haryana 30.88%, Delhi 23.5%, and Bihar 7.35%. Visual acuity varied from 6/6 to no perception of light. Open globe injury was observed in 56 patients (82.35%) who commonly had zone I injury. A significant number of patients (88.23%) were aware of firecracker-related injuries, and a large number of such injuries (58.8%) occurred in those who were not actively involved in the ignition of firecrackers but were in the vicinity. Conclusion This year, following a ban, the number of firecracker-related ocular injuries reported from areas outside Delhi outnumbered as compared to within Delhi. However, firecracker-related ocular injuries are still a major cause of significant visual loss, especially involving the bystanders. Thus, firecracker-related celebrations should be monitored with a stringent protocol.
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Affiliation(s)
- Amar Pujari
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Atul Kumar
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rohan Chawla
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Sudarshan Khokhar
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Divya Agarwal
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Meghal Gagrani
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Namrata Sharma
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Pradeep Sharma
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Chang IT, Prendes MA, Tarbet KJ, Amadi AJ, Chang SH, Shaftel SS. Ocular injuries from fireworks: the 11-year experience of a US level I trauma center. Eye (Lond) 2016; 30:1324-1330. [PMID: 27285323 PMCID: PMC5129850 DOI: 10.1038/eye.2016.104] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Accepted: 04/07/2016] [Indexed: 11/09/2022] Open
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.
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Affiliation(s)
- I T Chang
- Division of Oculoplastic Surgery, Department of Ophthalmology, University of Washington School of Medicine, Seattle, WA 98104, USA
| | - M A Prendes
- Division of Oculoplastic Surgery, Department of Ophthalmology, University of Washington School of Medicine, Seattle, WA 98104, USA
| | - K J Tarbet
- Division of Oculoplastic Surgery, Department of Ophthalmology, University of Washington School of Medicine, Seattle, WA 98104, USA
| | - A J Amadi
- Division of Oculoplastic Surgery, Department of Ophthalmology, University of Washington School of Medicine, Seattle, WA 98104, USA
| | - S-H Chang
- Division of Oculoplastic Surgery, Department of Ophthalmology, University of Washington School of Medicine, Seattle, WA 98104, USA
| | - S S Shaftel
- Department of Ophthalmology, Southern California Permanente Medical Group, San Diego, CA 92120, USA
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Elangovan S, Rajalakshmi AR, Velayutham V, Ranjit Prabhu D. An analysis of ocular firecracker injuries in five consecutive years during a festive season in a tertiary eye care hospital in South India. EXPERT REVIEW OF OPHTHALMOLOGY 2016. [DOI: 10.1080/17469899.2016.1176913] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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14
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Kong Y, Tang X, Kong B, Jiang H, Chen Y. Six-year clinical study of firework-related eye injuries in North China. Postgrad Med J 2015; 91:26-9. [DOI: 10.1136/postgradmedj-2014-132837] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
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.
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Affiliation(s)
- Ravija Patel
- a Orbit, Oculoplasty, Aesthetic and Reconstructive Services, Sankara Nethralaya , Chennai , India , and
| | - Bipasha Mukherjee
- b Orbit, Oculoplasty, Trauma, Aesthetic and Reconstructive Surgery, A Unit of Medical Research Foundation, Sankara Nethralaya , Chennai , India
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16
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Wang C, Zhao R, Du WL, Ning FG, Zhang GA. Firework injuries at a major trauma and burn center: A five-year prospective study. Burns 2014; 40:305-10. [DOI: 10.1016/j.burns.2013.06.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Revised: 05/13/2013] [Accepted: 06/04/2013] [Indexed: 11/25/2022]
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17
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Five-year study of ocular injuries due to fireworks in India. Int Ophthalmol 2013; 33:381-5. [DOI: 10.1007/s10792-013-9714-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Accepted: 01/02/2013] [Indexed: 10/27/2022]
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18
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Saadat S, Mafi M, Smith G. Higher education does not protect against firework-related injuries: A review of the economic burden and the risk factors of firework-related injuries in the capital of Iran. Public Health 2012; 126:40-6. [PMID: 22137095 DOI: 10.1016/j.puhe.2011.09.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Revised: 04/16/2011] [Accepted: 09/15/2011] [Indexed: 10/14/2022]
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19
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Kunz SN, Zinka B, Peschel O, Fieseler S. Accidental head explosion: an unusual blast wave injury as a result of self-made fireworks. Forensic Sci Int 2011; 210:e4-6. [PMID: 21570222 DOI: 10.1016/j.forsciint.2011.04.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Revised: 03/28/2011] [Accepted: 04/08/2011] [Indexed: 10/18/2022]
Abstract
A 33-year old hobby pyrotechnician sustained a lethal craniofacial trauma secondary to a salute fireworks blast. He was examining a misfire of a self-constructed salute gun, when it detonated, causing an explosively rupture of his forehead, which led to his immediate death. An autopsy was performed to achieve knowledge of the injury and to be able to reconstruct the events that lead to it. The pressure effect of the explosion caused a shredded rupture of the forehead with a regional spread of brain tissue and small polygonal skull fragments up to 30m from the detonation site. Furthermore multiple cinderlike fragments of black powder were embedded in the skin of the face and the anterior aspect of the neck (s.c. blast tattoo). The complete destruction of the forehead in combination with the multiple blast tattooing suggested that the explosion detonated while he was leaning over the device.
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Affiliation(s)
- S N Kunz
- Institute of Forensic Medicine, Ludwigs - Maximilians University, Munich, Germany.
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20
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Ocular burns and related injuries due to fireworks during the Aidil Fitri celebration on the East Coast of the Peninsular Malaysia. Burns 2011; 37:170-3. [DOI: 10.1016/j.burns.2010.05.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Revised: 05/11/2010] [Accepted: 05/25/2010] [Indexed: 11/17/2022]
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21
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Saadat S, Naseripour M, Smith GA. The health and economic impact of fireworks-related injuries in Iran: a household survey following the New Year's Festival in Tehran. Injury 2010; 41:e28-33. [PMID: 19539923 DOI: 10.1016/j.injury.2009.02.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2008] [Revised: 02/01/2009] [Accepted: 02/03/2009] [Indexed: 02/02/2023]
Abstract
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.
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Affiliation(s)
- Soheil Saadat
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
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22
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Kumar R, Puttanna M, Sriprakash KS, Sujatha Rathod BL, Prabhakaran VC. Firecracker eye injuries during Deepavali festival: a case series. Indian J Ophthalmol 2010; 58:157-9. [PMID: 20195044 PMCID: PMC2854452 DOI: 10.4103/0301-4738.60095] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2009] [Accepted: 10/16/2009] [Indexed: 11/08/2022] Open
Abstract
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.
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Affiliation(s)
- Ravi Kumar
- Department of Ophthalmology, Minto Ophthalmic Hospital, Bangalore, India
| | - Manohar Puttanna
- Department of Ophthalmology, Minto Ophthalmic Hospital, Bangalore, India
| | - K S Sriprakash
- Department of Ophthalmology, Minto Ophthalmic Hospital, Bangalore, India
| | - B L Sujatha Rathod
- Department of Ophthalmology, Minto Ophthalmic Hospital, Bangalore, India
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23
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Clinical analysis of firework-related ocular injuries during Spring Festival 2009. Graefes Arch Clin Exp Ophthalmol 2010; 248:333-8. [DOI: 10.1007/s00417-009-1292-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2009] [Revised: 12/23/2009] [Accepted: 12/24/2009] [Indexed: 10/19/2022] Open
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24
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Mansouri MR, Mohammadi SF, Hatef E, Rahbari H, Khazanehdari MS, Zandi P, Moghimi S, Piri N, Fahim A. The Persian Wednesday Eve Festival “Charshanbe-Soori” Fireworks Eye Injuries: A Case Series. Ophthalmic Epidemiol 2009; 14:17-24. [PMID: 17365814 DOI: 10.1080/09286580600878836] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To describe the clinical spectrum and severity of eye injuries sustained during the Persian Wednesday Eve Festival "Charshanbe-Soori" and to identify the fireworks devices involved. METHODS Prospectively, consecutive patients treated for fireworks-related eye injuries in the emergency room at Farabi Eye Hospital, Tehran, over 3 days around the occasion in 2000, 2001, and 2002 were studied. RESULTS Four hundred thirty-seven cases of eye injuries with an age range of 2-74 (median 17; SD 11.1) years were studied: 84.6% were male; 18.6% of the injuries were bilateral; 79.9% of the injured were bystanders or passersby. Eleven types of devices were involved, of which seven were explosives and eight were homemade. "Narenjaks," homemade grenades, were involved in 62.2%, firecrackers in 14.8%, and sparklers in 6.2% of the events. Injuries were categorized as severe in 49% of cases, and 45 (10.4%) people were hospitalized. Five eyes with no light perception and/or enucleation, 33 cases of monocular blindness, 54 (12.3%) cases of open globe (including intraocular foreign bodies) were observed. Grenades, bystander and passerby roles, outdoor context, a relatively older age, lower socioeconomic status, and male gender in the subset of passive roles were the determinants of more severe injuries (all p values < 0.05). Lid injuries (67.7%), corneal abrasions (51.6%), hyphema (48.1%), superficial foreign bodies (32.5%), and corneal contusions (13.8%) were the five leading injuries. CONCLUSIONS In Iran, fireworks cause frequent and diverse injuries during the Wednesday Eve Festival and are a leading cause of severe eye injuries and monocular blindness.
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Affiliation(s)
- Mohammad-Reza Mansouri
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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25
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Mehta S, Agarwal V, Jiandani P. Ocular injuries in survivors of improvised explosive devices (IED) in commuter trains. BMC Emerg Med 2007; 7:16. [PMID: 17900340 PMCID: PMC2071908 DOI: 10.1186/1471-227x-7-16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2007] [Accepted: 09/27/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ocular injuries are common in survivors of terror incidents that involve the use of explosive materials. These explosives are commonly of a High Explosive type (HE) and may be fashioned into improvised explosive devices (IED) that incorporate additional materials to maximise trauma and injuries. Serial IED explosions have occurred in commuter trains in several cities including London and Madrid but data on ocular injuries is limited. We report the ocular injuries of the survivors of a series of IED explosions in crowded commuter trains. METHODS 28 patients (56 eyes, 28 male, ages ranging from 22 to 52 years (mean 35.27 years) were screened in the triage area or the Intensive Care Unit (ICU). Testing included bedside visual acuity testing, torchlight examination of the anterior segment and dilated (or if necessary, undilated) fundus examination. Selected patients underwent B-scan examination, magnetic resonance imaging of the brain, orbits and the optic nerves or visual evoked potential assessment. The injuries, investigations and procedures were entered into the patient's case sheet as well as into a standardised format suggested by the Indian eye injury registry (IER). RESULTS 16 of 28 patients (57.1%) had ocular injuries whereas 12 (42.8%) were found to be normal. Injuries were seen unilaterally in 10 patients and bilaterally in six yielding a total of 22 injured eyes. The common injuries were periorbital haemorrhages (09 eyes, 40%); first or second degree burns to the upper or lower lids (seen in 07 eyes, 31.8 %) and corneal injuries (seen in 08 eyes, 36.3%). Open globe injuries were seen in two eyes of two patients (09%). One patient (4.5%) had a traumatic optic neuropathy. CONCLUSION Ophthalmologists and traumatologists should be aware of these patterns of ocular injuries. Protocols need to include the screening of large numbers of patients in a short time, diagnostic tests (B scan, visual evoked potential (VEP) etc) and early surgery preferably at the initial triage itself as most of the serious injuries in our studies had been missed or not treated at an initial assessment.
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Affiliation(s)
- Salil Mehta
- Dept of Ophthalmology, Lilavati Hospital and Research Centre, Mumbai, India
| | - Vinay Agarwal
- Dept of Ophthalmology, Lilavati Hospital and Research Centre, Mumbai, India
| | - Prakash Jiandani
- Dept of Critical Care Medicine, Lilavati Hospital and Research Centre, Mumbai, India
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26
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Shimazaki J, Konomi K, Shimmura S, Tsubota K. Ocular Surface Reconstruction for Thermal Burns Caused by Fireworks. Cornea 2006; 25:139-45. [PMID: 16371771 DOI: 10.1097/01.ico.0000180083.59244.8f] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE 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). METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Jun Shimazaki
- Department of Ophthalmology, Tokyo Dental College, Chiba, Japan.
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El Sayed F, Ammoury A, Dhaybi R. Treatment of fireworks tattoos with the Q-switched ruby laser. Dermatol Surg 2005; 31:706-8. [PMID: 15996426 DOI: 10.1111/j.1524-4725.2005.31620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The best approach in managing patients with explosive traumatic tattoos is the immediate removal of particles during initial care. Delayed treatment makes the situation more difficult to manage. Under certain conditions, a Q-switched ruby laser can be considered an excellent alternative. METHODS We report a new case of multiple facial fireworks tattooing managed successfully with a Q-switched ruby laser under low fluency pulses at 4.5 J/cm2. A pretreatment test zone was initially performed, and then three treatments were conducted at 6-week intervals. RESULTS More than 75% of the lesions were removed without scarring. CONCLUSION The Q-switched ruby laser can be a safe and excellent choice for the removal of explosive particles.
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Affiliation(s)
- Fouad El Sayed
- Division of Dermatology, Faculty of Medicine, Lebanese University, Beirut, Lebanon.
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Chan WC, Knox FA, McGinnity FG, Sharkey JA. Serious eye and adnexal injuries from fireworks in Northern Ireland before and after lifting of the firework ban- an ophthalmology unit?s experience. Int Ophthalmol 2004; 25:167-9. [PMID: 15847316 DOI: 10.1007/s10792-004-1958-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND/AIMS To report serious fireworks-related eye and adnexal injuries presenting to the Department of Ophthalmology in the Royal Victoria Hospital, Belfast. To assess the effect of lifting of the legislative ban on fireworks in Northern Ireland in 1996. METHOD Twelve year retrospective review from 1990 to 2001 inclusive of all ocular and adnexal injuries from fireworks requiring hospitalisation to the ophthalmology department. RESULTS Twenty three patients with 23 injured eyes were reported. Six were female. The mean age was 18 years (+/- 13 SD). Six patients presented between the years 1990 and 1995. The remaining 17 patients presented between 1996 and 2001. Nearly half of the patients required ophthalmic surgical procedures. Thirty-six percent of patients had a final visual acuity of 6/60 or less. Superficial trauma not requiring hospitalisation was not included. CONCLUSION Removal of the legislative ban on fireworks in 1996 has had a significant effect on the incidence of eye injuries. These injuries are potentially preventable with stricter control on the availability of fireworks and a greater awareness of the ocular risks they pose.
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Affiliation(s)
- W C Chan
- Department of Ophthalmology, Royal Victoria Hospital, Belfast, N. Ireland
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