Spectrum of Ocular Injuries and Visual Outcome Following Firework Injury to the Eye.

BACKGROUND

Ocular injury due to fireworks requires urgent ophthalmic assessment and management to preserve vision.

METHODS

Spectrum of injury, type of intervention, visual outcome, and reasons for visual loss were assessed in consecutive patients presenting over 2 years with firework-related eye injury. The final visual outcome was recorded as best-corrected visual acuity.

RESULTS

In the 96 patients (75 males) enrolled, 122 eyes were involved. Twenty-six patients had bilateral eye injury. The median (interquartile) age was 14 (8, 28.5) years. Injuries occurred during Diwali festival (59.4%) and funeral processions (20.8%); over half (53.8%) were bystanders. Injury was due to negligence (78%), device malfunction (12.5%), and attempts to reignite (5.2%) or recover failed device (4.2%). Presenting symptoms were redness (100%), pain (97%), watering (86%), and reduced vision (77%). Facial laceration, contusion, or hematoma occurred in 13 patients. The most frequent adnexal and ocular surface injuries were lid burns (57.3%), edema (44.2%), charred eyelashes (24.6%), and laceration (13.9%). Open-globe injury occurred in 8 eyes. Common anterior segment injuries were corneal epithelial defect (51.6%) and hyphema (20.5%). Posterior segment injuries included commotio retinae (13.1%) and Berlin's edema (7.4%). Surgical treatment was required in 15 eyes; 107 (88%) were managed conservatively. At study completion, of the 99 eyes evaluated, 21 had reduced visual acuity (<6/6) including 7 with monocular blindness. Factors associated with poor vision were open-globe injury ( < 0.001) and poor initial visual acuity ( = 0.05).

CONCLUSIONS

Open-globe injury and poor visual acuity at presentation predict the final visual outcome. Monocular blindness following firecracker injury is common.