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Indian Journal of Community Medicine

Letter to Editor: Profile of Fireworks Related Ocular Injuries (FROI) from Western India

Author(s): S. Barhanpurkar, P. Kumar, P. Kapadia

Vol. 30, No. 3 (2005-07 - 2005-09)

The festivity of Diwali is invariably vitiated due to the spurious quality fireworks and their negligent handling leading to fireworks related ocular injuries (FROI). Studies conducted in our country either do not deal with relevant factors adquately or have limited validity due to small sample. The fact that FROI are easier to prevent than to manage, prompted us to study the pattern, epidemiological factors and treatment seeking behavior for such injuries. We conducted this study with the objectives to (1) generate epidemiological and clinical profile of FROI cases and (2) assess the existing treatment seeking behavior of these cases.

This study was conducted at Surat, Rajkot and Vadodara during 2001 and 2002. Forty four cases reporting with FROI were included in the study. Detailed history of each case was obtained that included type of firework, mode of injury, other associated injuries etc. For children (< 12 years), enquiry was made whether the FROI occurred when the child was under the adult supervision. All cases were thoroughly examined on torchlight and slit lamp bio-microscope by faculty members/ residents of Ophthalmology department. Information for 14 cases (2002) was deficient in referral pattern and ultimate outcome. Depending on the severity, cases were treated on outdoor/indoor basis.

Twenty-four cases (54.5%) were children (<12 years), all cases except 6 were males. Only 4 cases including 1 female were in the age group of 35 years and above. Bombs were the commonest fireworks (70.5%) incriminated. Others were rockets, missiles, cone fountains, sparklers, Agarbatti (scent stick), combination firework and match stick.

The injuries occurred significantly more (56.8%) during evening between 1800-0000 hours followed by morning (25% between 0600-1200 hours). Very few injuries occurred during early morning or afternoon. This difference was statistically significant (X2 = 37.5, df = 1, p <0.001). Total of 20 victimes (45.5%) were innocent bystanders when they were watching others lighting fireworks. Another common pattern reported (n=8) was when a person ignites a bomb and it fails to explode, the person goes near the bomb to ignite it again and this time the bomb explodes on the person.s face (catching him unaware) inflicting injuries. Out of 24 affected children, only 2 (8.3%) had some adult supervision while lighting the fireworks.

Injuries were unilateral in 29 (65.9%) and bilateral in rest (34.1%) of cases. 12 patients had associated/co-existing injuries such as facial burns, limb injury and nasal bleeding. Most injuries were mild (corneal injury and lid injury) and managed on outdoor basis. Out of 30 cases, 28 (93.3%) were directly brought to these centers while 2 patients came after one referral. Similar information for 14 cases of 2002 was not available. Of 44 cases, on the spot treatment or 'first aid' was provided only to 26 (59.1%) patients. Methods used for the first aid were washing eyes with water or local application of antibiotic or both. In one case buttermilk was used for washing the eyes. A time lag of 6 hours or more in seeking medical care was seen in one fourth of the cases (22.7%), while one patient came as late as 36 hours. Duration of hospital stay amongst admitted patients (9) varied between 2 to 12 days. Mean and median durations of hospital stay were 5.6 ± of 3.6 days and 4 days respectively.

Out of the 44 cases, received conservative treatment while pateints were operated evisceration of eye cataract surgery with IOL implantation). Information about the ultimate recovery was available only for 30 cases and accordingly at the time of discharge/last follow up, 26 (86.7%) cases recovered fully while 4 had residual disabilities (eviscerated eye, corneal opacity, macular edema and retinal edema.

Fireworks industry in India is in unorganized sector and is stigmatized for patronizing child labor. It affects children twice first by engaging them in fireworks manufacturing and second time by inflicting firework associated injuries. In spite of many educative advertisements and warnings, FROI though fully preventable continue to occur in rural and urban areas.

Commonest group involved in our study was boys between 6-12 years age group. Preponderance of male children in FROI has been reported by others as well. It can be due to their adventurous and exploratory nature coupled with poor perception of risks associated with handling of fireworks. Male dominance in children in burn accidents is well documented and more pronounced below 4 years of age (Kumar et al, 1994). Male preponderance can also be due to the difference in treatment seeking behaviors of two sexes. Low incidence of FROI in females is due to their poor involvement in handling fireworks.The fact that 60 percent injuries occurred between 1800-2400 hours corresponds well with the pattern of celebration. However, this occurrence during late hours delays the seeking of primary or referral medical care (especially in remote places).

In this study, bombs were the main culprit of the FROI. Others1 also found same more so with severe cases requiring hospitalization (60%). It emphasizes the need for some quality check for the fireworks especially bombs. Combination fireworks are dangerous1 due to their uncertainty of time of explosion. Unsupervised ignition of fireworks by children and consequent FROI in our study was another aspect responsible for many injury cases. This aspect has been emphasized elsewhere also and must be incorporated in the IEC campaign.

The common injuries seen were corneal abrasions and foreign bodies in cornea; same were common in the study by Arya et al 20011. First aid was provided only to half of the cases.

This may have been due to the poor awareness or its non- availability. Both facts can be incorporated in the IEC program for example, a bucket full of water should be kept ready wherever fireworks are being lit and also some broad spectrum antibiotic eye drops should always be a part of the first aid kit of every home. Delayed arrival (>6 hours) of one fourth cases of the hospital in this study is another area of intervention with IEC.

Poor quality fuse leads in fireworks2,4 are responsible for uncertainty of the time of ignition.This has accounted for up to one fifth of the cases in our study. Fireworks industry needs to be brought under some supervision like ISI ratings. The packaging must exhibit instructiions for safe use and also for what to do as first aid measures in case of injuries. Framing the appropriate legislatiion and its enforcement can also be effective in this regard.

Limitations

Study covers cases which reported at Ophthalmology departments of medical colleges; therefore, findings can not be generalized on cases who may have visited private practioners/consultants. Small sample also limits the interpretation of the findings.

Acknowledgement

Authors acknowledge the contribution of Dr. Snehal Pandya (Rajkot), Dr. S.S. Gamit and Dr. H. Ahir (Vadodara) for data collection at respective centers.

References

  1. Arya SK, Malhotra S., Dhir SP, Sood S. Ocular Fireworks Injuries, Clinical Features & Visual Outcome. Indian Journal of Ophthalmology 2001; 49:189-190.
  2. Dhir S.P. Munjal V.P Malhotra S. Fireworks injuries of the eye-a preventable hazard. Indian Journal of Preventive and Social Medicine 2001; 32:31-34.
  3. Kumar P, Sharma M & Chaddha A. Epidemiological determinants of burn in pediatric and adolescent cases from a center of Western India. Burns 1994; 20:236-240.
  4. Mohan K, Dhir SP, Munjal V.P Jain IS. Ocular fireworks injuries in children. Afro-Asian J Ophthalmol. 1984; 2: 162 165.

S. Barhanpurkar, P. Kumar, P. Kapadia
Upgraded Department Ophthalmology & Department of Community Medicine,
Govt. Medical College & New Civil Hospital, Surat 395 001.
e-mail: [email protected]

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