Serious Eye Injuries Associated with Fireworks -- United States, 1990-1994

Eye injuries caused by fireworks are often severe and can cause permanently reduced visual acuity or blindness. Findings from the National Electronic Injury Surveillance System database maintained by the U.S. Consumer Product Safety Commission (CPSC) indicate that approximately 12,000 persons are treated each year in U.S. emergency departments because of fireworks-related injuries; of these, an estimated 20% are eye injuries. To improve characterization of fireworks-related eye injuries, data were analyzed from the United States Eye Injury Registry (USEIR) for July 1990-December 1994 and from the Eye Injury Registry of Alabama (EIRA) for August 1982-July 1989. This report summarizes the findings of these analyses. United States Eye Injury Registry

USEIR, a nonprofit organization sponsored by the Helen Keller Eye Research Foundation, is a federation of state eye registries that uses a standardized form to obtain voluntarily reported data on eye injuries and to obtain 6-month follow-up information. Reports are made by ophthalmologists to the USEIR database in Birmingham, Alabama. The primary purpose of USEIR is to provide prospective, population-based, epidemiologic data to improve the prevention and control of eye injuries. The registry contains information only for patients who have sustained a serious eye injury, defined as "an injury resulting in permanent and significant, structural or functional ocular change." USEIR comprises 39 state registry affiliates (representing 89% of the U.S. population); 32 states registered injuries during 1990-1994, and 27 states reported fireworks-related injuries during this period.

From July 1990 through December 1994, a total of 4575 serious eye injuries from all causes were reported to USEIR; of the 274 (6%) fireworks-related injuries, 255 (93%) were unintentional injuries. Persons injured by fireworks were aged 4-63 years (median: 15 years); 211 (77%) were males. The largest proportion (123 {45%}) of injured persons were bystanders; 96 (35%) were fireworks operators, and for 55 (20%), status was unknown. Most (219 {80%}) injuries occurred during the Independence Day holiday period * ; 44 (16%) occurred during the New Year's holiday period *, and 11 (4%) at other times. Most (67%) injuries occurred at home; injuries also occurred in recreational settings (14%), on a street or highway (5%), and in parking lots or occupational settings (1%). Location was unknown for 13%.

Most injuries were caused by bottle rockets (58%) Figure_1. Bottle rockets accounted for 68% of the injuries to bystanders. Eye Injury Registry of Alabama

A retrospective review was begun in 1989 of severely injured persons registered from August 1982 through July 1989 through the EIRA, the first state registry of USEIR. Reports to the EIRA are made by Alabama ophthalmologists. Data were obtained from EIRA standard report forms and from direct interviews with each injured person and/or family members.

Of the 70 fireworks-related injuries reported, 40 (57%) occurred during the Independence Day holiday period, and 27 (39%) occurred during the New Year's holiday period. These injuries resulted in legal blindness in 31 (44%) injured persons; in addition, enucleation was required for seven (10%). Bottle rockets accounted for 58 (83%) injuries, including eight of 10 injuries resulting in permanent damage to the optic nerve and all those resulting in enucleation.

Patients who sustained eye injuries resulting from bottle rockets reported that factors associated with their injuries included product misuse, (e.g., the intentional aiming of the device at others {"bottle rocket wars"} and throwing the device after it had been lit but before ignition), device malfunction (especially immediate explosion after ignition), erratic flight characteristics even when used according to manufacturers' instructions, and device ricochet off hard surfaces (e.g., a car or the street). Reported by: S Brown, MPH, CD Witherspoon, MD, R Morris, MD, SM Hamilton, MD, FI Camesasca, MD, JA Kimble, MD, United States Eye Injury Registry, Birmingham, Alabama. Directorate for Epidemiology and Health Sciences, Div of Hazard Analysis, US Consumer Product Safety Commission. Div of Unintentional Injury Prevention, National Center for Injury Prevention and Control, CDC.

Editorial Note

Editorial Note: Irreversible consequences -- including reduced visual acuity and blindness -- can result from the use of consumer fireworks, especially bottle rockets. Analysis of the USEIR database indicated that a high proportion of fireworks-related injuries occurred among young males -- a finding consistent with previous reports (1,2). These findings are similar to the results of a study in Washington in which injuries were associated with improper use (both intentional and unintentional), product malfunctions (e.g., short fuses, erratic flight, or tip-over), and high temperature (2).

Consumer fireworks -- including bottle rockets (classified as 1.4G {formally known as Class C} fireworks) -- have been banned in 10 states (Arizona, Connecticut, Delaware, Georgia, Massachusetts, Minnesota, New Jersey, New York, Rhode Island, and Vermont). Six states (Illinois, Iowa, Maine, Maryland, Ohio, and Pennsylvania) permit the use only of sparklers and other novelties (e.g., poppers, wheels, and snaps). The District of Columbia and 32 states allow at least some 1.4G fireworks to be sold. Nevada and Hawaii have no laws regulating fireworks except for local ordinances. The CPSC has banned firecrackers with greater than 50 mg pyrotechnic composition (including cherry bombs, M-80s, and silver salutes) designed to detonate on or near the ground and reloadable shell devices with diameters exceeding 1.75 inches; bottle-rockets can contain up to 130 mg pyrotechnic composition.

Because of the risks for injury associated with bottle rockets and other fireworks, several organizations have made specific recommendations regarding their use. USEIR recommends that persons attend public fireworks displays; however, if persons choose to use fireworks, USEIR recommends that they not use bottle rockets, and when other fireworks are used, eye protection should be worn by operators, bystanders, and spectators. CPSC and USEIR also advise that young children should never use fireworks, older children should be supervised when using fireworks, fireworks should be used only outdoors, a source of water should always be nearby for fire and to douse malfunctioning fireworks, instructions should be read and followed carefully, and malfunctioning fireworks should not be relit.

Several states have prohibited bottle rocket sales, and such bans are supported by the American Academy of Ophthalmology (3), American Academy of Pediatrics (4), and American Public Health Association (5). Despite the advisories regarding the dangers of fireworks use and state bans on use, fireworks continue to cause serious eye injuries -- fireworks purchasers often cross state borders during holiday seasons to obtain fireworks that are illegal in their own states. In addition, because USEIR is a voluntary registry and not all states are affiliated, the numbers presented in this report may underestimate the problem nationally. CDC, concurring with the USEIR recommendations, suggests that health-care providers urge patients and their families to attend professionally conducted public displays of fireworks.

References

1. CDC. Fireworks-related injuries -- Marion County, Indiana, 1986-1991. MMWR 1992;41:451-4.

2. CDC. Fireworks-related injuries -- Washington. MMWR 1983;32:285-6.

3. Eye Safety and Sports Ophthalmology Committee. Fireworks remain serious health hazard and cause of blindness. San Francisco: American Academy of Ophthalmology, May 1995.

4. Committee on Injury and Poison Prevention. Children and fireworks. Pediatr 1991;88:652-3.

5. American Public Health Association. Resolution 9111 -- banning bottle rockets: prevention of ocular injuries. In: American Public Health Association. Public policy statements of the American Public Health Association. Washington, DC: American Public Health Association, 1994: 482-3.

* The number of days for the holiday period varied each year. 

** The U.S. Consumer Product Safety Commission (CPSC) staff contributed injury data and information for this article; however, the views expressed in the article do not necessarily represent those of the CPSC.

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