Epidemiology of Firework-Related Eye Injuries From 2002 to 2021

Background Improper use of fireworks can lead to traumatic eye injuries, especially around the Fourth of July. This study investigates emergency department presentations of firework-related eye injuries across demographic factors and identifies notable injury trends over the last 20 years using the National Electronic Injury Surveillance System (NEISS). Methodology We queried the NEISS database for firework-related eye injuries from 2002 to 2021 using product code 1313 and body part codes 77 (eye) and 76 (face). Cases were stratified by age, sex, month, year of injury, and injury type for descriptive statistical analysis. Spearman's rank correlation was conducted to assess annual trends. Results Between January 1, 2002, and December 31, 2021, there were 1,213 reported cases in NEISS, corresponding to an estimated 41,708 (95% confidence interval = 31,913-51,500) emergency department visits nationally. Of these, 871 (71.8%) occurred in males and 342 (28.2%) in females. Patients aged ≤18 years comprised 752 (62.0%) cases, including 327 (27.0%) children aged 6-11 years. Contusions were the most common injury type (484 cases, 39.9%). The majority of injuries occurred in July (850 cases, 70.1%). Annual injury totals demonstrated a weak negative, statistically non-significant correlation over time (r = -0.26, p = 0.268), with notable increases in 2005, 2020, and 2021. Conclusions When both eye and facial injury codes are included, periocular contusions represent the most common firework-related ocular trauma, differing from prior studies that reported thermal burns. The disproportionate burden of injury among minors and the strong seasonal clustering in July underscore the need for enhanced preventive education and regulatory measures surrounding consumer fireworks.