Toy gun-related ocular injuries in the United States children: an analysis of national emergency department data from 2005 to 2024

Purpose: Toy guns are popular among children but can pose serious risks of eye injury. This study analyzed toy gun-related ocular injuries (TGOIs) in pediatric patients over 20 years using the United States national data. Methods: A retrospective cross-sectional analysis was performed using the U.S. National Electronic Injury Surveillance System data from 2005 through 2024. We studied cases of pediatric patients presenting to emergency departments with TGOIs. Descriptive and comparative analyses were performed, and trends were analyzed across the study period, using chi-square test and analysis of variance. Results: A total of 695 pediatric cases of TGOI were identified, corresponding to an estimated 16,325 national cases in the U.S. Most injuries occurred in males (77.4%) and age of 7-12 years (54.0%). Common diagnoses included corneal abrasion (33.5%) and hyphema (22.2%), with severe cases also reported such as ruptured globe (1.0%) and corneal laceration (0.3%). Injuries were most frequent during winter (32.1%). Over the study period, there were increases in mean age (from 8.9 years [2005-2009] to 9.6 years [2020-2024]), overall reported number of cases (from 47 to 341), and diagnosis of hyphema (from 8.5% to 25.2%). Conclusions: Pediatric TGOI is increasing in frequency, with shifting demographic and clinical patterns. These findings highlight the urgent need for enhanced safety regulations and public health interventions to prevent vision-threatening trauma in children.