Firecracker Injury to Eye

From Medscape Ophthalmology > Interactive Case Series
A 5-Year-Old With Firecracker Injury to the Eye
Caroline L. Belanger, MD; Kimberly G. Yen, MD; Evelyn A. Paysse, MD

Posted: 12/17/2009

Firecracker damage to the eye can result in mechanical, thermal, and chemical injury. Most firecrackers are made of flash-powder, a mixture of oxidizer and metallic fuel that burns quickly and, if confined, produces a loud noise.[1] Metallic particles, such as aluminum, may be found in firecrackers, and they can appear radio-opaque on CT scans.

The treatment for chemical injury to the eye from a firecracker includes copious irrigation of the eye as soon as the injury is detected.
Any remaining particles in the fornices should be removed because they can cause tissue necrosis.
A shield is recommended to protect the eye and a regimen of cycloplegics and steroid drops or ointments should be started as soon as possible to decrease inflammation. Amniotic membranes are thought to deliver anti-inflammatory factors to the ocular surface, thus reducing scarring and providing a protective structure where the epithelial cells could replicate.
Steroids must be decreased after 1 week of treatment because they can inhibit wound healing and promote infection.

Treatment for the 4 grades of corneal burns must be adjusted according to the severity of injury.
In a grade 1 corneal burn, only corneal epithelial loss is present and no conjunctival ischemia is found. The prognosis is very good.
Grade 2 is associated with some corneal edema and corneal haze; conjunctival ischemia affects less than one third of the limbus and some permanent scarring may occur.
Grade 3 is associated with significant haziness of the cornea, and limbal ischemia is less than one half of the limbus. Prognosis is variable and vision is usually impaired. Finally, a corneal burn is grade 4. The cornea is opaque, and limbal ischemia affects greater than one half of the limbus.
Grade 4 burns may be associated with globe perforation, and the prognosis is poor.

Fireworks-related Injuries
Fireworks are thought to have originated in China[5] and are commonly used throughout the world to celebrate the New Year, Independence Day (United States), Halloween, and many smaller festivals.

In 2006, 9200 people were treated in emergency departments for fireworks-related injuries in the United States.[1] One of every 3 people injured were children younger than 15 years, with boys being affected 3 times more frequently than girls.[1] Some reports state that people actively participating in fireworks-related activities are more frequently and severely injured than bystanders.[1] The body parts most often injured were hands, eyes, and the head, face, and ear.[6] Common injures that occur are blindness, third-degree burns, and permanent scarring.[1]

Burns were the most common injury to all body parts, except the eyes and head, where contusions, lacerations, and foreign bodies in the eye occurred more frequently.[1] Although fewer injuries were associated with items such as sparklers and rockets,[1] one third of the injuries to children younger than 5 years were due to sparklers.[1] Injuries resulting from public fireworks displays are extremely rare. Risk factors for injuries include proximity to the device; lack of physical coordination necessary to safely handle fireworks, such as in the case of younger children; and curiosity, a common factor in children.[1] Alcohol consumption is also admitted in a high percentage of patients with fireworks injuries.[6]

Preventive safety measures when working with firecrackers, such as wearing safety glasses, have been shown to be effective in reducing the number of injuries.[6]
The World Health Organization (1984) has recommended a worldwide ban on the manufacture of all fireworks.

My note: Wear Eye protection when playing with firecrackers - they can blind u!!