Firework-Related Ocular Trauma Higher in Areas Without Firework Bans

A case-control study published in JAMA Ophthalmology found that residents in areas where fireworks were legal had higher odds of firework-related ocular trauma when compared with residents in areas where fireworks were banned, although future studies need to be done to assess how greater reductions in ocular trauma could be achieved.

Of the firework-related emergency department visits in the US, 16% are ocular injuries, with an estimated 1840 firework-related ocular injuries occurring per year. Young males are the most frequently affected demographic, with corneal burns, foreign bodies, and hyphemas the most frequent injuries. No research has evaluated the association between the regulation of fireworks and ocular injury, so this study aimed to evaluate the association between local bans of fireworks and rates of firework-related ocular injury in Washington state.

Sparkler with blurred busy city light background | Image credit: phive2015 - stock.adobe.com

The case-control study was retrospective in nature and took place from June 28 to July 11 in all years between 2016 and 2022. The level 1 trauma center Harborview Medical Center in Seattle was used as the location of the study. Ophthalmology service call records were used to collect data. These call records included data from consultations made from 5 PM to 8 AM on weeknights and all day on weekends and holidays. Clinic hours during the daytime were not included.

All injuries categorized as ocular trauma were split into firework-related injuries and non–firework-related injuries, which was used as the control group. Injuries to the eyes were also split into vision threatening and non–vision threatening, the former of which included severe ocular burn, hyphema, retinal or choroidal injury, intraocular foreign body, dislocated lens, orbital fracture, and open globe injury. Lastly, visual acuity outcomes were split into groups of 20/40 or better, 20/50 to 20/200, worse than 20/200, and unknown. Patients who were 18 years and older were compared with patients younger than 18 years.

There were 230 ocular trauma injuries during the study period, of which 94 patients had sustained the injury due to fireworks. These patients had a mean (SD) age of 25 (14) and were 92% male. The patients who had non–firework-related injuries had a mean age of 43 (23) years and were 77% male.

Odds of an injury related to fireworks were higher in patients who were male (OR, 3.3; 95% CI, 1.5-7.1) and younger than 18 years (OR, 3.1; 95% CI, 1.7-5.8). A total of 60% were non-Hispanic White, followed by 17% Hispanic or Latino/a and 12% Black. No differences were found in the ethnicities between ocular trauma related to fireworks and that not related to fireworks. A total of 84% of patients lived in urban areas for both firework-related and non–firework-related injuries; 5% of patients who lived in rural areas had firework-related injuries compared with 1% of patients in rural areas who had non–firework-related injuries (OR, 7.6; 95% CI, 1.0-89.9).

Corneal abrasion (52%), hyphema (32%), and corneal foreign bodies (15%) were the most common injuries related to fireworks. Orbital fractures (36%), corneal abrasion (29%), and conjunctival or corneal laceration (17%) were the most common eye injuries in those who weren’t injured due to fireworks.

Ocular trauma occurrence had higher odds in areas where fireworks were legal compared with areas where fireworks were banned (OR, 2.0; 95% CI, 1.2-3.5). Vision-threatening injuries were more likely in patients with injuries due to fireworks compared with injuries not related to fireworks (OR, 2.1; 95% CI, 1.2-3.5). Vision-threatening injuries were not more common in either areas where fireworks were banned or where fireworks weren’t banned. Higher odds of corneal abrasion (OR, 2.6; 95% CI, 1.5-4.6), corneal foreign body (OR, 7.8; 95% CI, 2.2-25.8), and hyphema (OR, 5.3; 95% CI, 2.5-11.7) were found in firework-related injuries.

There were some limitations to this study. This study was conducted in a single center, which may make it not generalizable to other parts of the United States. Dates of purchase weren’t recorded, which made the legality of fireworks at the time of purchase unknown. An increase in personal fireworks could have been possible due to the COVID-19 pandemic. There were a low number of injuries overall, and follow-up data were available for less than 25% of patients.

An association was found between ocular trauma and the legality of fireworks in Washington. “The design of this case-control study does not establish cause and effect but provides hypothesis-generating ideas to aid in future investigations of the association of legislation with the incidence of firework-related ocular injuries and vision-threatening ocular trauma,” the authors wrote.

Reference

Harrison L, Yee P, Sundararajan M, Ding L, Feng S. Local firework restrictions and ocular trauma. JAMA Ophthalmol. Published online December 14, 2023. doi:10.1001/jamaophthalmol.2023.5698