With June nearly behind us and the flood clean-up underway, many may see the upcoming Fourth of July festivities as a well deserved chance to celebrate.

Last year, approximately 6,400 Americans spent part of the Fourth of July holiday in the emergency room. According to the American Society of Ocular Trauma, an average of 400 Americans permanently lose vision in one or both eyes due to fireworks injuries annually.

Culver Boldt, MD,  ophthalmologist at University of Iowa Hospitals and Clinics, talks about precautions needed for a safe holiday weekend:

What kind of eye injuries do you see from fireworks?

Most of the injuries to the eye are the result of the shockwave created by the explosion or trauma from a rapidly moving projectile. Sometimes that projectile is the fireworks itself, like a bottle rocket, but often the projectile comes from placing the firework into a container, such as a bottle or can, and having it explode. Occasionally people are lucky and they sustain only minor injuries like corneal abrasions, but unfortunately, we often times see bleeding in the eye, and retinal damage, or even rupture of the eye. About half of the injuries result in vision loss so bad that you can barely see the big E on the eye chart. About one in 10 of the injuries required removal of the eye.

Who is most likely to be injured by fireworks?

Over the last 15 years, we've collected a lot of data on fireworks injuries through the United States Eye Injury Registry and younger people are definitely more likely to be injured. Most of the eye injuries occur in individuals 16 years of age or younger, with about three-quarters of those injuries being in males. Nearly half of the injuries were in bystanders. About two-thirds of eye injuries caused by fireworks occur at home, and this is in stark contrast to eye injuries from professional fireworks displays, which are really rare.

Are there certain types of fireworks that are more likely to cause eye injuries?

From an eye standpoint, bottle rockets are definitely the worst. They cause about two-thirds of all reported fireworks injuries to the eyes. In addition, bottle rockets cause the most severe eye injuries. They tend to travel at high speeds and take an unpredictable trajectory, so injuries often times occur with unsuspecting bystanders who happen to be within a few hundred feet of the launch site. But they also occur when people try to relight the bottle rocket and lean over the bottle.

If an eye injury occurs from fireworks, what treatment steps should be taken?

First, don't touch, rub, or press on the eye, because this can cause further damage. Don't try to wash out the eye or pull out any kind of foreign object from the eye because this does more damage.

It's best if you can cover the eye with a protective shield to minimize further damage. In a pinch, even a paper or Styrofoam cup taped over the eye will do. If the vision is blurred, seek medical attention quicly, even if the eye doesn't hurt. If you feel anything other than a minor explosive force to hit your eye or eyelid, even if the vision is normal,   have a physician examine they eye because there are some silent but potentially blinding injuries, such as retinal tears or injuries that predispose to glaucoma, that could have occurred and you wouldn't even know it.

Do you have any tips to enjoy a safe Fourth of July with fireworks?

I'd never like you to use bottle rockets, but if you are going to operate fireworks at home, safety eyewear should be used by both the operators and the spectators. Never use illegal or homemade fireworks. Never try to relight malfunctioning fireworks. This is a common cause of injury.

Don't put fireworks in glass bottles, or tin cans, or clay pots, because these can shatter and cause serious injuries. Finally, I recommend that people attend professionally sponsored public fireworks displays on the Fourth of July. This is a safe and enjoyable way to celebrate the holiday.

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Culver Boldt, MD

American Society of Ocular Trauma

United States Eye Injury Registry