CASE REPORT: FIRECRACKER-RELATED OCULAR TRAUMA
A 27-year-old male was referred to the Bochner Eye Institute following an ocular injury to the right eye, sustained when a firecracker exploded in close proximity. He reported the sudden onset of decreased vision. Initial assessment was performed at a local emergency department, after which he was referred to Bochner Eye for further management.
EXAMINATION
- Best-corrected visual acuity (BCVA) was 20/200 in the right eye and 20/20 in the left eye.
- Intraocular pressures measured 26 mmHg in the right eye and 18 mmHg in the left eye.
- Right eye revealed a large central corneal epithelial defect and a hyphema occupying approximately one-third of the anterior chamber.
- Visualization of the crystalline lens and fundus in the right eye was limited due to the presence of blood in the anterior chamber.
- The anterior segment and fundus examination of the left eye were normal.
- B-scan ultrasonography of the right eye was performed and ruled out an underlying retinal detachment.
ASSESSMENT
- Right eye trauma secondary to firecracker explosion, complicated by corneal epithelial defect and hyphema.
TREATMENT PLAN
- A bandage contact lens was applied to facilitate epithelial healing.
- Started on Vigamox (moxifloxacin) four times daily and Cosopt (dorzolamide-timolol) twice daily to control intraocular pressure.
- Re-epithelialization of the cornea was confirmed at 3 days, and the bandage contact lens was removed.
- Topical corticosteroid therapy with Pred Forte (prednisolone acetate 1%) was initiated at four times daily, and Vigamox was reduced to twice daily.
Over the subsequent weeks, the hyphema gradually resolved, but the patient’s visual acuity was limited to 20/100 secondary to the finding of a macular hole.
NATURE OF FIRECRACKER INJURIES TO THE EYES:
1. TYPES OF OCULAR INJURIES
Firecracker injuries can cause a wide spectrum of ocular damage, ranging from mild to catastrophic. The injuries generally fall into the following categories:
A. MECHANICAL INJURIES
- Corneal abrasions: From flying debris or small particles.
- Penetrating injuries: From shrapnel or fragments directly entering the globe.
- Globe rupture: High-velocity impacts can cause full-thickness ocular wall rupture.
- Intraocular foreign bodies (IOFB): Metallic or organic fragments penetrating into the anterior or posterior segment.
B. THERMAL INJURIES
- Direct burns to eyelids, conjunctiva, or cornea due to heat exposure.
- Severe thermal exposure may cause full-thickness burns and scarring.
C. CHEMICAL INJURIES
- Alkali or acidic chemicals in some fireworks can lead to:
- Conjunctivitis
- Corneal opacification
- Limbal stem cell deficiency
D. BLAST INJURIES (Barotrauma)
Sudden pressure waves can cause:
- Hyphema
- Retinal detachment
- Macular holes
- Vitreous hemorrhage
- Optic nerve damage
E. SECONDARY INFECTIONS
- Open globe injuries have a high risk of endophthalmitis, especially if contaminated material enters the eye.
2. SEVERITY SPECTRUM
- ~15-20% may result in permanent vision loss.
- Children account for a large proportion of victims.
- Bystanders often sustain more injuries than actual users.
PREVENTION OF FIRECRACKER EYE INJURIES
1. PUBLIC EDUCATION
Awareness campaigns emphasizing dangers, especially around holidays.
Promote supervised professional displays rather than home fireworks.
2. PROTECTIVE EYEWEAR
Polycarbonate safety glasses when handling or observing fireworks.
Even professional handlers should wear full protective goggles.
3. LEGAL REGULATIONS
Restrictions or bans on personal firework use can dramatically reduce injuries (e.g. stricter laws in parts of Europe).
Licensing requirements for purchase and use.
4. SAFE HANDLING PRACTICES
Never allow children to ignite fireworks.
Always point fireworks away from people, homes, and flammable objects.
Maintain safe distances and avoid relighting “duds.”
Never hold lit fireworks in your hand.
5. PROPER DISPOSAL
Soak used fireworks in water before discarding to avoid accidental delayed ignition.
CLINICAL TAKE-HOME MESSAGE
- Any ocular trauma from fireworks should be treated as a potential open globe injury until proven otherwise.
- Immediate ophthalmic evaluation is critical.
- Early surgical intervention often improves outcomes.
FINAL THOUGHTS
This case highlights the potentially devastating ocular consequences of firecracker-related injuries. Even without full-thickness globe rupture or penetrating trauma, the combination of corneal epithelial defects, hyphema, elevated intraocular pressure, and posterior segment involvement can lead to significant and sometimes permanent vision loss. In this patient, the development of a traumatic macular hole ultimately limited visual recovery, despite prompt medical management and resolution of anterior segment findings.
The case underscores the importance of early ophthalmologic evaluation following ocular trauma, comprehensive anterior and posterior segment assessment—including the use of B-scan ultrasonography when visualization is compromised—and close follow-up to monitor for secondary complications. Public education, strict safety measures, and regulatory controls remain essential in reducing the incidence of these preventable injuries, particularly around holidays when firework use peaks.
Ultimately, firecracker injuries serve as a sobering reminder that vision loss can occur in a matter of seconds, and the best treatment remains prevention.
