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Original Investigation
April 9, 2020

Assessment of Firework-Related Ocular Injury in the US

Author Affiliations
  • 1Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
  • 2Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania, Philadelphia
  • 3Wills Eye Hospital, Glaucoma Service, Philadelphia, Pennsylvania
JAMA Ophthalmol. 2020;138(6):618-623. doi:10.1001/jamaophthalmol.2020.0832
Key Points

Question  What are the factors associated with firework-related ocular injuries in the US?

Findings  In this cross-sectional study of a nationally representative hospital database, nearly 2000 firework-related ocular injuries occurred annually between 1999 and 2017, with most injuries occurring in July and January. Ocular burns were the most frequent type of injury, and bottle rockets were a common firework type that disproportionally caused serious ocular injury, including ruptured globe.

Meaning  These findings may inform preventive methods to decrease firework-related ocular morbidity, especially around national holidays.


Importance  Fireworks are popularly used for recreation but can lead to potentially blinding injuries. Studies quantifying the trend and national prevalence of firework-related ocular injuries are limited.

Objective  To characterize firework-related ocular injuries treated in emergency departments (EDs) in the US from 1999 to 2017.

Design, Setting, and Participants  This cross-sectional study used the National Electronic Injury Surveillance System, a stratified probability sample of more than 100 hospital-affiliated US EDs representing more than 5300 nationwide hospitals. Deidentified individuals in the National Electronic Injury Surveillance System database who experienced eye injury due to fireworks between January 1, 1999, and December 31, 2017, were included. Analysis began February 2019.

Main Outcomes and Measures  Annual prevalence of firework-related ocular injury, firework type stratified by demographic information, diagnosis, event location/date, and patient disposition.

Results  A total of 34 548 firework-related ocular injuries were seen in US EDs during the 19-year study period (estimated from 1007 individuals in the National Electronic Injury Surveillance System database). Overall, 664 individuals (65.9%) were 18 years or younger, 724 (71.9%) were male, and 512 (50.8%) were white. Twenty-eight patients (2.8%) sustained a ruptured globe, while 633 (62.9%) sustained ocular burn injuries, 118 (11.7%) had ocular foreign bodies, 97 (9.6%) had conjunctival irritation, and 46 (4.6%) experienced other severe eye trauma. Of 1007 individuals, 911 (90.5%) were treated and released without transfer, while 87 (8.7%) required admission or transfer to another hospital. The most common specified firework types included firecrackers (193 [19.2%]), bottle rockets (177 [17.6%]), sparklers (88 [8.7%]), roman candles (66 [6.6%]), and novelty devices (65 [6.5%]) (eg, poppers and snappers). Bottle rockets disproportionately caused the most severe injuries, including ruptured globe (odds ratio, 5.82; 95% CI, 2.72-12.46; P < .001). A total of 411 cases (74.9%) occurred at home. Injuries most commonly occurred near the time of Independence Day and New Year’s Day: 707 patients (70.2%) presented in July, 74 (7.4%) in June, 101 (10.0%) in January, and 47 (4.7%) in December.

Conclusions and Relevance  These findings support that firework-related ocular injuries range from mild irritation to ruptured globe, and most occur frequently in those who are young, male, and white. Focused preventive methods and regulations may be imperative in decreasing fireworks-related ocular morbidity, namely from bottle rockets and especially near national holidays.

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