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

Ocular Firework Injuries among Patients Presented to the Emergency Department During Festival Season in a Tertiary Eye Hospital

Introduction

Fireworks can cause severe ocular injuries which can be prevented if used with proper precautions. It causes not only mechanical injuries but also thermal and chemical injuries. This study aimed to find out the prevalence of ocular firework injuries among patients presented to the emergency department during festival season in a tertiary eye hospital.

Methods

This is a descriptive cross-sectional study done among patients presenting in the emergency department of a tertiary eye hospital after obtaining ethical approval from the Institutional Review Committee. Data of patients from medical records between 26 October 2021 to 28 November 2021 and 15 October 2022 to 17 November 2022 was collected. A convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval.

Results

Among 132 patients, the prevalence of ocular firework injuries was seen in 73 (55.30%) (46.82-63.78, 95% Confidence Interval). Closed globe injury was mostly observed in 56 (76.71%) patients with ocular injuries. The most common age group affected was those less than 30 years old 54 (73.97%).

Conclusions

The prevalence of ocular firework injuries was found to be lower than other studies done in similar settings. Protective measures should be used to prevent ocular injuries. A public awareness program needs to be launched before such festivals.

Keywords

festivals; injuries; prevalence.

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.

[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.