Commentary: Firework related ocular trauma - Have we learnt our lessons?

Fireworks are commonly used in India during the festival of Diwali, as well as during certain funerals, New Year, Christmas, etc.[1] Ocular trauma forms a major chunk of injuries from inappropriate use of fireworks. While most injuries are closed globe, open-globe injuries are seen in up to 17% of patients, which is a poor predicting factor for visual gain.[2] Most of the affected individuals are male and comprise individuals of the younger age group, resulting in a socioeconomic burden in society. Approximately one-third of affected individuals develop bilateral eye injuries.[3] More than half the patients who suffer ocular injuries from firecracker injuries are innocent bystanders.[1234] Majority of the children develop firecracker-related eye injuries when they are using them without supervision.[2] These are serious causes of concern for our society.

In terms of temporal trends, the situation seems to have gotten worse with time. A single-hospital study has shown an increase in firecracker-related open-globe injuries from 7.1% in 1996–1998 to 16.8% in 2005–2009.[2] A 5-year retrospective review of firework-related ocular injuries in southern China showed that the annual number of patients with firework-related eye injuries remained stable annually.[5] Chan et al.[6] reported a threefold increase in eye injuries secondary to fireworks after lifting the ban on fireworks in Northern Ireland. These show us that firecracker-related ocular injuries are a prevalent health hazard that requires urgent attention.

The way forward seems to be twofold: awareness and legislation. Citizens must be aware of the risk of eye injuries with the use of firecrackers, and the alarmingly high number of bystanders who develop eye injuries for no fault of their own should be reiterated to individuals. While firecrackers are an important part of festivities, people must be aware of the safety of certain crackers against others. Sparklers and ground spinners are relatively safer as compared to fountains, rockets, and bombs.[1] Practices such as reigniting crackers or recovering half-lit crackers should be discouraged. People must be careful while burning firecrackers and maintain a safe distance to prevent any projectile particles from causing eye injuries. Use of protective eyewear during the festive season (even among bystanders) must be encouraged. The Irish experience shows us clearly the importance of legislation in the prevention of firework-related ocular injuries.[6] The strict legislation in Hungary calling for a ban on firecrackers resulted in only 0.1% of the ocular injuries in the Hungarian Eye Injury Registry database being due to firecrackers.[7] Beneficial effects of effective legislature have also been seen closer back home.[8] Such legislature controlling sales as well as having quality control of firecrackers can help in not only reducing the incidence of firework-related trauma but also reducing air pollution.