Local Firework Bans May Reduce Risk of Ocular Trauma

Local bans on fireworks in the United States may be linked to a slight reduction in the likelihood of firework-related ocular trauma, according to new research published in JAMA Ophthalmology.¹

A case-control analysis of 230 patients presenting to a trauma center in Washington state with ocular trauma found that the odds of firework-related were moderately greater among people living in areas where fireworks were legal, compared with those living in areas with fireworks bans.

“The design of this case-control study does not establish cause and effect but provides hypothesis-generating ideas to aid in future investigations of the association of legislation with the incidence of firework-related ocular injuries and vision-threatening ocular trauma,” wrote the investigative team, led by Shu Feng, MD, department of ophthalmology at the University of Washington School of Medicine.

Over the past two decades, firework injuries across the United States have increased, with disproportionate effects on younger individuals. In particular, ocular injuries have been shown to account for approximately 16% of firework-related injuries, according to a 2022 annual report from the United States Consumer Product Safety Commission.² Demographic-related characteristics, type of injury, and firework-type associated with injuries have shown that firework-related ocular injuries primarily affect males, involve corneal burns and hyphemas, and occur most often due to firecrackers and bottle rockets.

However, Feng and colleagues indicated the association of legislation limiting the sale and use of fireworks with ocular injuries in the United States is not well understood.¹ Given the geographic proximity of disparate local fireworks policies and the ability of consumers to travel to purchase fireworks, they noted it is unclear whether local restrictions are effective in reducing ocular trauma. Noting the controversial firework restrictions in Washington state, the investigative team’s analysis aimed to assess whether local bans are associated with lower rates of firework-related ocular injury.

The team conducted a retrospective case-control study to evaluate the incidence of ocular trauma at a level 1 trauma center in Seattle, Washington surrounding the Independence Day holiday from June 28 to July 11 over 8 years (2016 to 2022). Data were collected from ophthalmology service call records, including documented after-hours consultations performed in the emergency department.

All cases of ocular trauma were classified into firework-related and non-firework-related injuries, while non-firework-related injuries served as the control group. All injuries were grouped as vision-threatening and non-vision-threatening. The likelihood of firework-related injuries among firework-legal areas versus firework-ban areas was calculated as odds ratios (ORs).

Among the 230 consultations for ocular trauma, 94 patients (mean age, 25 years; 86 males [92%]) sustained firework-related injuries and 136 patients (mean age, 43 years; 104 males [77%]) sustained non–firework-related injuries. Upon analysis, the odds of firework-related ocular trauma were higher in those in a firework-legal area compared with those living in an area where fireworks were banned (OR, 2.0; 95% CI, 1.2 - 3.5; P = .01).

The analysis revealed the likelihood of firework injuries was also greater for those younger than 18 years of age (OR, 3.1; 95%, 1.7 - 5.8; P <.001) and for male patients (OR, 3.3; 95% CI, 1.5 - 7.1; P = .004). Moreover, firework injuries were more likely to be vision-threatening (57%), compared with non-firework-related injuries (40%) (OR, 2.1 [95% CI, 1.2 - 3.5]; P = .01).

Feng and colleagues indicated that public health measures and awareness should thus focus on limiting the use of fireworks, particularly among younger people, given the observed greater proportion of firework-related injuries among younger populations.

“Legislation, including local bans, could be considered to decrease the morbidity of firework-related ocular trauma, and additional studies may determine what actions might lead to greater reductions in harm,” investigators added.

References

1. _{Harrison L, Yee P, Sundararajan M, Ding L, Feng S. Local Firework Restrictions and Ocular Trauma. JAMA Ophthalmol. Published online December 14, 2023. doi:10.1001/jamaophthalmol.2023.5698}
2. _{Smith B, Pledger D. 2022 Fireworks annual report. United States Consumer Product Safety Commission. Published online June 2023. Accessed December 21, 2023. https://www.cpsc.gov/s3fs-public/2022-Fireworks-Annual-Report.pdf}