• Written By:
    Comprehensive Ophthalmology, Pediatric Ophth/Strabismus

    Review of: Assessment of Firework-Related Ocular Injury in the US

    Shiuey E, Kolomeyer A, Kolomeyer N. JAMA Ophthalmology, April 2020

    This study characterized firework-related injuries in the United States to determine specific actionable associations that could guide public policies and reduce the extent of ocular injuries.

    Study design

    The authors used the National Electronic Injury Surveillance System (NEISS) to gather epidemiologic data on firework-related ocular injuries treated in U.S. emergency departments between 1999 and 2017. This data system was derived from a stratified probability sample of more than 100 hospital-affiliated emergency departments representing more than 5,300 nationwide hospitals.


    A total of 34,548 firework-related ocular injuries were seen in U.S. emergency departments during the 19-year study period, averaging 1,840 injuries per year. Nearly 70% of injuries occurred in July while 10% occurred in January. Injured individuals were often males (72%), aged 18 years or younger (66%) and white (51%).

    Approximately 63% of injuries were ocular burns, followed by ocular foreign bodies (12%), conjunctival irritation (10%) and ruptured globes (3%). The incidents were often due to firecrackers (19%), bottle rockets (18%), sparklers (9%), roman candles (7%) and novelty devices (7%). Rocket-type fireworks disproportionally caused the most severe ocular injuries, including ruptured globe (OR 5.82).


    These results may underestimate the full extent of ocular injury because the authors searched the NEISS database for cases in which fireworks injured only the eyeball. The analysis did not include cases in which other parts of the head were primarily injured and may have included ocular injuries. In addition, the national database did not include visual acuity, clinical examination or follow-up data, precluding the authors from evaluating patient morbidity or vision loss.

    Clinical significance

    The annual rates of all firework injuries have not significantly changed in the last 15 years. Firework-related ocular injuries—most commonly ocular burns—primarily occur in younger males around the time of national holidays. Bottle rockets are nearly 7 times more likely to cause severe eye trauma but are variably prohibited. These findings may help guide preventive methods and regulations to decrease firework-related ocular injuries.