Study Details Extent of Firework-Related Ocular Injuries From 1999-2017

New research from Wills Eye Hospital and Thomas Jefferson University is detailing the impact and severity of firework-related ocular injuries in the United States.

Using data representing more than 5300 hospitals nationwide from 1999-2017, the investigators’ analysis details the frequency and severity of the 34,548 injuries seen during the 19-year study period.

In an effort to further evaluate factors associated with firework-related ocular injuries in the US, investigators designed a cross-sectional study using the Consumer Product Safety Commission’s National Electronic Injury Surveillance System (NEISS) database, which is derived from a stratified probability sample of more than 100 hospitals in the US—representing more than 5300 nationwide hospitals. A total of 1007 firework-related ocular injuries were identified using the database, which represents an estimated 34,548 injuries.

Investigators information from the database included in the study included age, sex, injured body port, case disposition and a description of events, but not visual acuity, follow-up information, or comorbidities. Additionally, investigators pointed out orbital and periorbital soft tissue injuries were not included in the analysis and eye injury visits were stratified by age, month, race/ethnicity, sex, diagnosis, case disposition, and location of incident.

The mean age of patients included was 17.3 years, 71.9% were men, and 50.8% were white—of note, 65.9% were under 18 years of age. The most common injury was ocular burn (62.9%) followed by ocular foreign body (11.7%) and conjunctival irritation (9.6%). Investigators noted 2.8% of individuals sustained ruptured globes and 3.5% had hyphema.

Results of the analysis indicated firecrackers (19.2%), bottle rockets (17.6%), sparklers (8.7%), and Roman candles (6.6%) were among the most common type of firework used—nearly a third (32.1%) did not classified as unspecified type. Most patients (90.5%) were treated and released without transfer.

Investigators pointed out results of the analysis indicated multiple associations between firework type and diagnosis. Specifically, statistically significant associations were noted between firecrackers and ocular burn (AR, 2.1), public displays and foreign bodies (AR, 6.6), and sparklers and conjunctival irritation (AR, 2.5). Results suggested rocket-type fireworks were significantly associated with ruptured globe (AR, 5.1; OR, 5.82; 95% CI, 2.72-12.46; P <.001) and other forms of severe eye trauma (OR 6.78; 95% CI, 4.66-9.85; P <.001).

When analyzing time and location of injury, results indicated 74.9% of injuries occurred at home and most occurred in July, June, January, and December, respectively. In total, 70.2% occurred in July, 7.4% in June, 10.0% in January, and 4.7% in December.

Investigators noted multiple limitations in their study, mostly relating to its reliance on NEISS data. Specific limitations listed include lack of data on visual acuity, exclusion of cases in which other parts of the head were injured but may have featured ocular injury, and limitations within the NEISS database itself.

Based on the results of their study and prior data related to consumer firework injuries, investigators suggest increased regulation could help in decreasing the rate of firework-related ocular injury in the US.

“The effects of increased regulation to prevent the use and purchase of consumer fireworks on incidence of related injury has been well documented in non-US countries. Countries that have banned the sale of all fireworks have lower rates of firework-related injuries,” investigators wrote.

This study, “Assessment of Firework-Related Ocular Injury in the US,” is published in JAMA Ophthalmology.