Fireworks, particularly when used by non-professionals, can lead to serious injuries and even death. Of the various injuries caused by fireworks, those to the eyes and hands are among the most frequent.
Over the years, there have been several measures taken by the relevant bodies to restrict the use by private individuals of fireworks in order to reduce the incidence of associated injuries. For example, in the European Directive 2013/29/EU, the European Union classified the different types of pyrotechnic articles, according to their dangerousness, indicating which can be used by the general public and in what manner. Previously, in 1984, the World Health Organisation (WHO) had banned fireworks completely. Indeed, it has been observed that in countries with stricter rules on pyrotechnic articles, there is a lower incidence of accidents. For example, in Northern Ireland, the ban on fireworks was lifted in 1996, which led to an increase in the incidence and rate of firework-induced eye injuries. Specifically, eye injuries increased from 0.85% to 2.9% after the ban was lifted.
Types of ocular trauma from fireworks
A recent study, conducted in Germany, evaluated and analysed eye injuries recorded in Berlin over a four-year period during the Christmas holidays.
In agreement with previous publications, patients with ocular trauma from fireworks were predominantly male (71.2%) and under 30 years of age (69.2%).
Fortunately, most of the injuries caused by fireworks were mild (66.4%), with rapid resolution and no impact on vision. Corneal abrasions were found in 40% of the subjects.
Moderate trauma, including eyeball contusion, accounted for 23.3% of cases and severe trauma for 10.3%. Thus, about one third of firework-related eye injuries have the potential to cause permanent damage or sequelae, such as secondary glaucoma or central retinal atrophy.
Among those who suffered serious eye injuries, minors (under the age of 18) accounted for 60%. The study seems, therefore, to suggest that younger people are at higher risk of suffering eye injuries caused by fireworks. There could be several reasons for this finding, including a higher risk when actively handling fireworks and a lower awareness of the potential dangers in younger children who, however, will suffer from eye damage throughout their lives.
Visual acuity at the last follow-up was also analysed to find out the severity of the ocular trauma suffered. In patients with severe trauma, visual acuity was significantly reduced.
The enucleation rate reported in the study was 0.68%, a lower figure than in past publications, suggesting that more advanced treatment options now save more eyes.
The importance of prevention
Injuries caused by fireworks are a preventable health risk. For example, in Norway, institutions have educated the population about the proper handling of fireworks and the use of safety glasses. Stricter prohibition measures have further reduced injuries caused by fireworks. Indeed, a comparison of international data on the incidence of firework injuries shows that countries with stricter laws record 87% fewer eye injuries than those with more liberal laws on the private use of fireworks.
Since, as seen above, a significant proportion of those injured by fireworks, particularly those with serious injuries, are minors, stricter rules on the use of fireworks should have a significant protective impact for this age group.
But what can we do in our own small way? Adult supervision is certainly necessary and it has been shown that this can also prevent injuries to bystanders, who do not directly handle the fireworks, but watch the show. In fact, studies have shown that spectators are more likely to be hit and suffer eye injuries than others. In the study analysed, in particular, a 60% of eye injuries was recorded in passive subjects, who therefore did not actively handle firecrackers.
Further help, therefore, could come from stricter bans on the use of fireworks in more densely populated areas and, especially, in the vicinity of children.