Tips to combat firework eye injury horrors

While many people across the United States are hosting barbeques, attending parades and firework displays, and picnicking with their families today, ophthalmologists may find themselves celebrating Independence Day a little differently-handling emergencies due to firework-related eye injuries.

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Over the past 3 years, the number of eye injuries caused by fireworks has more than doubled, the American Academy of Ophthalmology warned this week.

The latest annual fireworks injury report issued by the U.S. Consumer Product Safety Commission stated that 1,300 eye injuries related to fireworks were treated in U.S. emergency rooms in 2014-up from 600 just 3 years ago.

Types of fireworks eye injuries can include burns to the eye and eyelid, abrasions that result in infections and scarring, retinal detachment, and rupture of the eyeball.

The 2015 fireworks survey by the Academy in San Francisco found that only 10% of U.S. adults wear eye protection when using fireworks, yet 3 times that number wear eye protection when they do other activities such as home repairs or house cleaning.

Many ophthalmologists have never come across a firework-related eye injury case during their career, but due to the incidents’ rising number, this soon may change.

Tony Pira, MD-clinical director, department of ophthalmology, Boston Medical Center-shares his story of the first time he was confronted with a firework-related eye injury, and offers advice to his colleagues who may find themselves in a similar situation this weekend:

I started my ophthalmology residency at Washington University in St. Louis back in 2000. I was a brand new eye resident, and my first day of call was July 4.

In Missouri, consumer purchasing of fireworks is legal. I was with a more senior resident taking “buddy” call. At first, all seemed well. We had some frozen custard, a St. Louis staple, and watched fireworks from atop the parking structure. However, a call came from the emergency department.

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Two young boys, around 13 years old, had been playing with fireworks. Specifically, they were having a “bottle rocket fight,” in which they fired bottle rockets at each other. This turned out exactly as one might fear, as one of the boys was hit in the eye by a bottle rocket.

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Human reflexes are fast, but the power of gunpowder is such that the speed of fireworks and shrapnel are much faster than our blink reflex. Thankfully, the family didn’t try prying open the eye or rinsing it out; they went directly to St. Louis Children’s Hospital.

The emergency room did a good job, too. When we arrived, there was a foxshield, which is a metal shield with perforations in it, covering the eye. If a foxshield isn’t available, a Styrofoam cup works well, or any type of light cup taped over the eye.

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It’s so very important to avoid any pressure on the eye, because if there is a laceration, or hole, in the eye, pressing on it can cause much more damage as contents of the eye exit the wound.

Under the supervision of my senior resident, I carefully removed the shield and gently lifted the lid. Even as a brand new resident, I knew there was a lot of damage, but I was still naïve, so I asked the obvious question: “Is there supposed to be blood and air inside the eye?” My senior resident replied with a sigh, “No, Tony, there is not.”

The patient went to the operating room than night for repair of his ruptured globe, and spent a few days in the hospital. Unfortunately, he suffered some permanent loss of vision.

Thankfully, I’m now in a state in which consumer purchase of fireworks is illegal, but fireworks are readily available over the state line and via the Internet.

Obviously, having a bottle rocket fight is unsafe, but even when using fireworks “safely,” one can easily become injured because of the speed and unpredictability of fireworks. Eye protection via shatterproof glasses or goggles would help, but not as much as leaving the fireworks to the experts.

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In addition to direct trauma from the firework or shrapnel causing a rupture globe, one can have foreign material lodged in the cornea, the front surface of the eye, or even gunpowder burns-which can leave permanent scarring and loss of vision.

But again, the biggest worry is a ruptured globe, so it’s imperative to protect the eye with a cover that does not place any pressure on the eye itself, and to seek emergency care immediately.

Next: Beyond globe rupture advice

Signs of globe rupture include 360 degrees of bullous subconjunctival hemorrhage and low IOP. Check to make sure that the anterior chamber is formed. If there are any wounds that may be penetrating, checking to see if the wound is Seidel positive is helpful.

A dilated exam can reveal choroidal and retinal damage that may suggest a posterior globe rupture.

If there is no globe rupture, certainly any foreign material in the cornea or conjunctival may be removed at the slit lamp and appropriate topical antibiotic coverage started. Corneal burns can be difficult to manage. Referral to a corneal specialist is warranted in those cases.

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If there is no globe rupture but chemical injury is suspected, checking the pH and starting copious irrigation with normal saline until the pH is normalized is indicated.