Avoid eye injury: Leave fireworks to the professionals
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Summer holidays, specifically July 4, bring fireworks to the forefront of conversation every year, but the exciting explosions can pose physical dangers, including to the eyes.
Matthew F. Gardiner, MD, director of ophthalmology emergency, consult and hospitalist services at Mass Eye and Ear, spoke with Healio/OSN about the dangers associated with at-home fireworks and why professional displays are a safer option.
Healio/OSN: What kind of year is Mass Eye and Ear anticipating in terms of ocular injuries attributable to fireworks?
Gardiner: We typically get the majority of our firework injuries in summer, starting in late June and early July around the July 4th holiday, and extending through the summer. My guess would be that we are going to have more firework injuries this year simply because of the pent-up demand. People have been in their houses and have been isolated for so long.
We saw a lot of home fireworks last year, because many of the town fireworks were canceled due to COVID. This year, there may be more organized, professional fireworks and less of a demand for people to do fireworks in their own backyard, so that may be a good thing, since those are safer, generally. At the same time, there may be more gatherings. People may get together in small groups in their backyard and then set off fireworks. It’s hard to know.
Healio/OSN: What kind of fireworks-related injuries does Mass Eye and Ear typically see over the summer months?
Gardiner: Mostly burns, open globe injuries and intraocular foreign bodies. When fireworks explode near a person’s face, they can suffer burns to their eyelids, the eyes themselves and their face. Most feared is the open globe injury. People who are very close to an explosion can have an intraocular foreign body or penetrating injury, which can be catastrophic and difficult to repair. An explosion can pretty much destroy the eye if the patient is very close to it, holding it in their hand, for example. Occult intraocular foreign bodies are also of significant concern. You can be farther away from the explosion but still have a foreign body pass through the cornea and into the eye without there being an obvious open globe.
Healio/OSN: What kinds of precautions can lay people take when celebrating with fireworks? Should they bother with them at all?
Gardiner: In many states, home fireworks are illegal. Are people who are setting off illegal fireworks going to take precautions? They obviously haven’t taken the precaution of not getting the illegal fireworks in the first place.
For anyone who is near something that is likely to explode, they should wear safety glasses and keep a safe distance away from the fireworks. Whenever you do anything where you’re likely to have a foreign body injury or traumatic injury to the eye, you should be wearing some kind of safety glasses – that goes for everything, including using the lawnmower, the weed wacker or cutting/grinding metal.
Healio/OSN: What should ophthalmologists be aware of during fireworks season?
Gardiner: Often we see corneal foreign bodies that result from pieces of the explosion flying into the eye, hitting the face, lids and cornea. The issue is that some of those particles go right through the cornea and into the eye, and it may not be initially obvious. If there have been multiple corneal foreign bodies, you may miss the one that became intraocular. It’s important to have a high level of suspicion - look for iris transillumination defects and small corneal wounds that may be faintly Seidel-positive. Don’t be afraid to do a b-scan or order a CT in cases with high-velocity projectile injury. Also, people who are exposed to explosions can have chemical injuries. Check the pH, make sure the corneal surface is not chemically burned in addition to being thermally injured.
Healio/OSN: Is it possible for the bright lights of fireworks to cause long-lasting harm, even if there is no physical trauma?
Gardiner: If fireworks are up in the sky, being done by professionals, and there is a significantly long distance between you and the explosion, then no. There is no risk for people observing fireworks set off by professionals. If you’re setting off something very close to you, then yes. Some fireworks burn at an extremely high temperature and can release a lot of light. So that, in theory, could cause photopic injury, but that is pretty rare.
Healio/OSN: Last year, it seemed as though firework season went on for much longer than normal. Has there been an uptick in cases at Mass Eye and Ear yet this year?
Gardiner: So far, not yet. It did seem to go on into the fall of last year, and I’m not sure exactly why. I’m hoping that with more town-sanctioned professional fireworks, there will be fewer personal firework activity extending beyond the season.
Healio/OSN: Anything else?
Gardiner: The most important thing for people to know is to let the professionals take care of the fireworks. In Massachusetts, we have strict fireworks laws. At Mass Eye and Ear, and at many other hospitals in the Boston area, the majority of the fireworks injuries that we see come from nearby states with lax or no rules for fireworks use. States that have good laws and restrictions in place have many fewer of these injuries.
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