Clinical Profile, Pattern of Injuries, and Visual Outcome Following Firecracker-Related Ocular Injury

Clinical Profile, Pattern of Injuries, and Visual Outcome Following Firecracker-Related Ocular Injury | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Clinical Profile, Pattern of Injuries, and Visual Outcome Following Firecracker-Related Ocular Injury Sabarinath Arunagiri, Usha Kim This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8027798/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose To analyze the demographics, types of ocular injuries, management strategies, and visual outcomes in patients presenting with firecracker-related ocular trauma. Methods This multicentric prospective study included 254 patients who presented to the emergency and outpatient departments during the Diwali festival in 2023. Results Among the 254 patients, 198 (77.9%) were male with a mean age of 19.76 ± 15.34 years. Unilateral involvement was seen in 211 patients (83.3%) The most common presenting complaint was defective vision (32%). 153 patients were active ignitors, while 99 (38.97%) were passive bystanders. Based on WHO guidelines, 198 patients (69.2%) had mild visual impairment at presentation, while 41 (14.3%) presented with blindness. According to the Birmingham Eye Trauma Terminology System (BETTS), 95.9% had closed globe injuries and 4.1% had open globe injuries. Discussion Ocular injuries caused by firecrackers can range from minor abrasions to devastating globe ruptures. The majority of the cases were young males, consistent with previous studies [1,2]. The high proportion of bystanders among the injured highlights the need for broader public awareness and control measures [3]. Most patients responded well to conservative management. However, open globe injuries and cases presenting with severe visual impairment or blindness had limited visual recovery. Conclusion Firecracker-related ocular trauma presented with a wide range of injuries, from minor burns to globe rupture, requiring varied treatment approaches. Unlike previous studies, over one-third of the affected individuals in our cohort were bystanders. Poorer outcomes were associated with severe visual impairment, blindness, and open globe injuries. Firecracker injury ocular trauma visual impairment open globe injury Diwali-related eye injuries BETTS classification preventive ophthalmology Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction Firecracker-related ocular injuries can range from mild visual impairment to complete blindness. These injuries are more commonly seen during festival seasons, particularly during Diwali celebrations. While several case series have reported on firecracker-related eye injuries, there is a relative paucity of comprehensive, prospective studies in the literature. (1–3).To address this gap, we conducted a prospective study to evaluate the clinical profile and visual outcomes of patients who sustained firecracker-related ocular injuries during Diwali 2023. Materials and Methods This multicentric prospective study included 254 patients who presented during the Diwali festival in 2023 at various centers of the Aravind Eye Care System in Tamil Nadu. Patients who presented to emergency and outpatient departments were included. Data collected included age, sex, laterality, best-corrected visual acuity (BCVA) at presentation, symptoms, type of firecracker involved, activity status (active participant or bystander), classification of ocular injury, treatment modalities, and visual outcome at follow-up. Visual acuity was converted in accordance with ETDRS (Early treatment diabetic retinopathy study) chart and LogMAR (logarithm of the minimal angle of resolution) for analysis. The logMAR values for counting fingers close to face (CFCF), hand movements (HM), PL, and no PL were 2. 3,2. 6,2. 9,3. respectively, as per the existing literature(8).Intraocular pressure was measured using rebound tonometer. B-scan ultrasonography, OCT, orbital X-ray, fundus photography, and gonioscopy were performed when indicated. We used the Birmingham Eye Trauma Terminology System (BETTS) to classify the ocular injuries. Statistical analysis All the statistical analysis was done using STATA software version 17 (Texas, USA).Continuous variables such as age were summarized using mean and standard deviation, while categorical variables like gender, type of injury, and presenting symptoms were expressed as frequencies and percentages. The association between injury type (closed vs. open globe) and visual outcomes was assessed using the Chi-square test or Fisher’s exact test as appropriate. Differences in visual acuity before and after treatment were compared using the Wilcoxon signed-rank test. A p-value < 0.05 was considered statistically significant. Results 1.General characteristics A total of 254 patients were included in this multicentric prospective study conducted across various centers of the Aravind Eye Care System in Tamil Nadu during the Diwali festival in 2023. The mean age of presentation was 19.76 ± 15.34 years, with the majority of cases seen in children and young adults aged 1–20 years (66.6%). Males accounted for 77.9% of the cases, while females comprised 22.1%, indicating a male predominance, which is consistent with previous literature on ocular trauma during festive seasons [1,2]. 2.Clinical presentation Most patients (83.1%) had unilateral eye involvement, and 16.9% had bilateral injuries. The most frequently reported symptom was defective vision (36.2%), followed by pain (26.4%), redness (18.1%), irritation (13.4%), and photophobia (5.9%). Intraocular pressure (IOP), measured when feasible, had a mean of 17.09 ± 7.93 mmHg. While 89.7% of patients were managed as outpatients, 10.3% required hospital admission, largely due to the severity of injuries. 3.Treatment Regarding treatment modalities, the majority (89.8%) of patients were treated conservatively, which included saline irrigation, topical antibiotics, artificial tears, cycloplegics, and steroids when indicated. Surgical intervention was required in 9.1% of cases, and only a small number underwent laser (0.8%) or other medical treatments (0.4%). Most patients (57.5%) presented on the same day as the injury, while others presented within 2 to 5 days. 4.Visual Acuity Visual acuity was assessed in 286 eyes. At presentation, the median visual acuity was 0.3 LogMAR (IQR: 0–0.78), equivalent to 6/12 Snellen acuity (6/6–6/36). Post-treatment, the median improved significantly to 0.18 LogMAR (IQR: 0–0.3), or approximately 6/9 Snellen acuity (6/6–6/12), with a statistically significant difference (p < 0.0001, Wilcoxon signed-rank test). At baseline, 69.2% of eyes had normal vision, 13.3% had visual impairment, 3.2% had severe visual impairment, and 14.3% were blind, as per WHO classification standards [3]. 5.Injury Classification and Patterns According to the Birmingham Eye Trauma Terminology System (BETTS), 95.9% of 297 injured eyes had closed globe injuries, while 4.1% had open globe injuries. This high proportion of closed globe injuries aligns with findings from similar Indian studies on firecracker-related ocular trauma [4,5]. Among the injured, 60.9% were active participants in lighting the firecrackers, while 39.1% were passive bystanders, reaffirming the vulnerability of onlookers as previously reported [6]. 6.Visual Outcome comparison Among the 162 eyes with normal vision at presentation, 128 (79.0%) retained normal vision post-treatment. Of the 38 eyes with initial visual impairment, 23 (14.2%) improved to normal. Additionally, 4 (2.5%) of the 9 eyes with severe visual impairment and 7 of the 41 blind eyes (17.1%) improved to normal vision post-treatment. Despite these improvements, statistical analysis using the McNemar test showed no significant association between presenting and post-treatment vision status (p > 0.05), possibly due to the smaller number of eyes in non-normal vision categories. Closed vs. Open Globe Injuries: Visual Prognosis Patients with closed globe injuries demonstrated a significant improvement in visual acuity post-treatment. Their median visual acuity improved from 0.18 LogMAR (IQR: 0–0.6) at presentation to 0 LogMAR (IQR: 0–0.3) post-treatment (p < 0.0001). In contrast, patients with open globe injuries showed limited improvement, with a median visual acuity of 2.6 LogMAR (IQR: 1.08–2.9) at presentation and 2.3 LogMAR (IQR: 0.93–2.75) post-treatment, which was not statistically significant (p = 0.3750). This suggests a notably poorer prognosis for open globe injuries, consistent with prior findings [4,7]. 7.BETTS Classification In closed globe injury (CGI) cases, 79.5% of eyes with normal presenting vision retained it, and 14.3% of eyes with visual impairment improved to normal. Out of 14 eyes that were blind at presentation, 7 (50%) showed improvement post-treatment. However, the McNemar test again showed no significant association (p > 0.05). In contrast, among the open globe injury (OGI) group, all 3 eyes that were blind at presentation remained blind after treatment. The small sample size in this group limits generalizability, but the trend clearly indicates a poorer outcome compared to closed globe injuries. These findings highlight the spectrum of visual outcomes and reinforce the need for preventive strategies during festivals involving firecrackers. Earlier studies have similarly emphasized the value of public education and stricter regulation of firecracker use to prevent such avoidable vision loss [6,8]. Discussion This study provides valuable insight into the clinical profile, pattern, and visual outcomes of firecracker-related ocular injuries during the Diwali festival. The predominance of young males among the affected population echoes previous findings in similar Indian studies, underscoring the high-risk nature of this demographic during festive seasons involving fireworks [1,2]. Notably, nearly 40% of the victims were passive bystanders, reaffirming the fact that not only users but also observers are vulnerable to firecracker injuries [6]. The majority of patients presented with closed globe injuries, which aligns with earlier reports emphasizing their prevalence in firecracker-related trauma [4,5]. Our study reaffirms the generally favorable visual prognosis in these cases, with significant improvement in post-treatment visual acuity. In contrast, eyes with open globe injuries showed minimal recovery, highlighting the devastating potential of such injuries and the importance of early surgical intervention and long-term rehabilitation [4,7]. A considerable proportion of patients presented with mild to moderate visual impairment at baseline, and many experienced substantial visual recovery following timely intervention. While 17.1% of blind eyes showed improvement to normal vision, statistical analysis did not find a significant correlation between presenting and final vision status, likely due to the small sample size in non-normal vision categories. Nevertheless, these improvements reflect the benefits of standardized management protocols and early treatment. Our findings underscore the importance of preventive strategies, particularly public awareness and education. The role of schools, community programs, and media campaigns in spreading awareness about firecracker safety is crucial. Implementation of safety regulations and strict quality control in firecracker manufacturing can play a vital role in reducing the burden of ocular injuries [6,8]. Conclusion Firecracker-related ocular injuries remain a significant cause of preventable visual morbidity, particularly during festive seasons like Diwali. This study demonstrates that while most cases involve closed globe injuries with favorable outcomes, open globe injuries continue to result in poor visual prognosis. A considerable proportion of those injured are bystanders, emphasizing the broader community risk. Timely intervention can lead to significant visual recovery, but prevention remains the cornerstone. Enhanced public education, stricter regulatory measures, and targeted safety campaigns are essential to reduce the incidence and severity of such injuries Declarations Declaration of Conflicting Interest - The authors declare that there are no conflicts of interest related to this work. Funding Statement -This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Ethical Approval and Informed Consent- The study was approved by the Institutional Ethics Committee of Aravind Eye Hospital, Madurai, Tamil Nadu, India, and adhered to the tenets of the Declaration of Helsinki. Written informed consent for treatment and inclusion of anonymized data in research was obtained from all participants (or their legal guardians, when applicable). Data Availability Statement -The datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request Acknowledgments - The authors gratefully acknowledge the support of the Department of orbit and oculoplastic services, Aravind Eye Hospital, Madurai, for facilitating data retrieval and patient follow-up during the course of this study. Clinical Trail number : Not applicable References Singh DV, Sharma N, Sinha R, Tandon R. Firecracker eye injuries during Diwali festival: A common but preventable cause of ocular morbidity. Indian J Ophthalmol. 2016;64(7):521–523. Ram J, Sukhija J, Bandyopadhyay S, et al. Firecracker injuries during Diwali festival: The epidemiology and impact on vision. Indian J Ophthalmol. 2015;63(12):946–949. World Health Organization. Change the Definition of Blindness [Internet]. Geneva: WHO; 2008. Kuhn F, Morris R, Witherspoon CD, et al. A standardized classification of ocular trauma. Ophthalmology. 1996;103(2):240–243. Agrawal R, Rao G. Firecracker injuries: A common cause of ocular trauma in India. Int J Inj Contr Saf Promot. 2006;13(3):129–132. Dhir SP, Chawla TN. Firework injuries of the eye. Indian J Ophthalmol. 1984;32(5):291–293. Jain S, Dandona L. Fireworks-related eye injuries in children: The Indian perspective. Eye (Lond). 2007;21(7):865–866. Dandona R, Dandona L. Ocular trauma in an urban population in southern India: The Andhra Pradesh Eye Disease Study. Clin Experiment Ophthalmol. 2003;31(5):395–401. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8027798","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":547159293,"identity":"88d0602e-21d5-44ff-bfe2-1398d0bae7b9","order_by":0,"name":"Sabarinath 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4","display":"","copyAsset":false,"role":"figure","size":74600,"visible":true,"origin":"","legend":"\u003cp\u003eVisual outcome comparison\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-8027798/v1/c6c90c604a87565b1bf04d78.png"},{"id":96422732,"identity":"9f79aee7-f5b2-4cb6-9ce6-b197c4fa787f","added_by":"auto","created_at":"2025-11-21 01:12:46","extension":"jpeg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":238033,"visible":true,"origin":"","legend":"\u003cp\u003eVisual outcome comparison based on WHO grading\u003c/p\u003e","description":"","filename":"floatimage14.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8027798/v1/e142d3e68d0fe9f56b5284a6.jpeg"},{"id":97139877,"identity":"34752ebd-968f-4f58-99aa-d655b5429aa8","added_by":"auto","created_at":"2025-12-01 10:02:55","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1182042,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8027798/v1/c65197d8-eab7-4c28-89f0-46edca265de9.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Clinical Profile, Pattern of Injuries, and Visual Outcome Following Firecracker-Related Ocular Injury","fulltext":[{"header":"Introduction","content":"\u003cp\u003eFirecracker-related ocular injuries can range from mild visual impairment to complete blindness. These injuries are more commonly seen during festival seasons, particularly during Diwali celebrations. While several case series have reported on firecracker-related eye injuries, there is a relative paucity of comprehensive, prospective studies in the literature. (1\u0026ndash;3).To address this gap, we conducted a prospective study to evaluate the clinical profile and visual outcomes of patients who sustained firecracker-related ocular injuries during Diwali 2023.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eThis multicentric prospective study included 254 patients who presented during the Diwali festival in 2023 at various centers of the Aravind Eye Care System in Tamil Nadu.\u003c/p\u003e\u003cp\u003ePatients who presented to emergency and outpatient departments were included.\u003c/p\u003e\u003cp\u003eData collected included age, sex, laterality, best-corrected visual acuity (BCVA) at presentation, symptoms, type of firecracker involved, activity status (active participant or bystander), classification of ocular injury, treatment modalities, and visual outcome at follow-up. Visual acuity was converted in accordance with ETDRS (Early treatment diabetic retinopathy study) chart and LogMAR (logarithm of the minimal angle of resolution) for analysis. The logMAR values for counting fingers close to face (CFCF), hand movements (HM), PL, and no PL were 2. 3,2. 6,2. 9,3. respectively, as per the existing literature(8).Intraocular pressure was measured using rebound tonometer. B-scan ultrasonography, OCT, orbital X-ray, fundus photography, and gonioscopy were performed when indicated. We used the Birmingham Eye Trauma Terminology System (BETTS) to classify the ocular injuries.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eAll the statistical analysis was done using STATA software version 17 (Texas, USA).Continuous variables such as age were summarized using mean and standard deviation, while categorical variables like gender, type of injury, and presenting symptoms were expressed as frequencies and percentages. The association between injury type (closed vs. open globe) and visual outcomes was assessed using the Chi-square test or Fisher\u0026rsquo;s exact test as appropriate. Differences in visual acuity before and after treatment were compared using the Wilcoxon signed-rank test. A p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cb\u003e1.General characteristics\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA total of 254 patients were included in this multicentric prospective study conducted across various centers of the Aravind Eye Care System in Tamil Nadu during the Diwali festival in 2023. The mean age of presentation was 19.76\u0026thinsp;\u0026plusmn;\u0026thinsp;15.34 years, with the majority of cases seen in children and young adults aged 1\u0026ndash;20 years (66.6%). Males accounted for 77.9% of the cases, while females comprised 22.1%, indicating a male predominance, which is consistent with previous literature on ocular trauma during festive seasons [1,2].\u003c/p\u003e\u003cp\u003e\u003cb\u003e2.Clinical presentation\u003c/b\u003e\u003c/p\u003e\u003cp\u003eMost patients (83.1%) had unilateral eye involvement, and 16.9% had bilateral injuries. The most frequently reported symptom was defective vision (36.2%), followed by pain (26.4%), redness (18.1%), irritation (13.4%), and photophobia (5.9%). Intraocular pressure (IOP), measured when feasible, had a mean of 17.09\u0026thinsp;\u0026plusmn;\u0026thinsp;7.93 mmHg. While 89.7% of patients were managed as outpatients, 10.3%\u003c/p\u003e\u003cp\u003erequired hospital admission, largely due to the severity of injuries.\u003c/p\u003e\u003cp\u003e\u003cb\u003e3.Treatment\u003c/b\u003e\u003c/p\u003e\u003cp\u003eRegarding treatment modalities, the majority (89.8%) of patients were treated conservatively, which included saline irrigation, topical antibiotics, artificial tears, cycloplegics, and steroids when indicated. Surgical intervention was required in 9.1% of cases, and only a small number underwent laser (0.8%) or other medical treatments (0.4%). Most patients (57.5%) presented on the same day as the injury, while others presented within 2 to 5 days.\u003c/p\u003e\u003cp\u003e\u003cb\u003e4.Visual Acuity\u003c/b\u003e\u003c/p\u003e\u003cp\u003eVisual acuity was assessed in 286 eyes. At presentation, the median visual acuity was 0.3 LogMAR (IQR: 0\u0026ndash;0.78), equivalent to 6/12 Snellen acuity (6/6\u0026ndash;6/36). Post-treatment, the median improved significantly to 0.18 LogMAR (IQR: 0\u0026ndash;0.3), or approximately 6/9 Snellen acuity (6/6\u0026ndash;6/12), with a statistically significant difference (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001, Wilcoxon signed-rank test). At baseline, 69.2% of eyes had normal vision, 13.3% had visual impairment, 3.2% had severe visual impairment, and 14.3% were blind, as per WHO classification standards [3].\u003c/p\u003e\u003cp\u003e\u003cb\u003e5.Injury Classification and Patterns\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAccording to the Birmingham Eye Trauma Terminology System (BETTS), 95.9% of 297 injured eyes had closed globe injuries, while 4.1% had open globe injuries. This high proportion of closed globe injuries aligns with findings from similar Indian studies on firecracker-related ocular trauma [4,5]. Among the injured, 60.9% were active participants in lighting the firecrackers, while 39.1% were passive bystanders, reaffirming the vulnerability of onlookers as previously reported [6].\u003c/p\u003e\u003cp\u003e\u003cb\u003e6.Visual Outcome comparison\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAmong the 162 eyes with normal vision at presentation, 128 (79.0%) retained normal vision post-treatment. Of the 38 eyes with initial visual impairment, 23 (14.2%) improved to normal. Additionally, 4 (2.5%) of the 9 eyes with severe visual impairment and 7 of the 41 blind eyes (17.1%) improved to normal vision post-treatment. Despite these improvements, statistical analysis using the McNemar test showed no significant association between presenting and post-treatment vision status (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05), possibly due to the smaller number of eyes in non-normal vision categories.\u003c/p\u003e\n\u003ch3\u003eClosed vs. Open Globe Injuries: Visual Prognosis\u003c/h3\u003e\n\u003cp\u003ePatients with closed globe injuries demonstrated a significant improvement in visual acuity post-treatment. Their median visual acuity improved from 0.18 LogMAR (IQR: 0\u0026ndash;0.6) at presentation to 0 LogMAR (IQR: 0\u0026ndash;0.3) post-treatment (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). In contrast, patients with open globe injuries showed limited improvement, with a median visual acuity of 2.6 LogMAR (IQR: 1.08\u0026ndash;2.9) at presentation and 2.3 LogMAR (IQR: 0.93\u0026ndash;2.75) post-treatment, which was not statistically significant (p\u0026thinsp;=\u0026thinsp;0.3750). This suggests a notably poorer prognosis for open globe injuries, consistent with prior findings [4,7].\u003c/p\u003e\u003cp\u003e\u003cb\u003e7.BETTS Classification\u003c/b\u003e\u003c/p\u003e\u003cp\u003eIn closed globe injury (CGI) cases, 79.5% of eyes with normal presenting vision retained it, and 14.3% of eyes with visual impairment improved to normal. Out of 14 eyes that were blind at presentation, 7 (50%) showed improvement post-treatment. However, the McNemar test again showed no significant association (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003eIn contrast, among the open globe injury (OGI) group, all 3 eyes that were blind at presentation remained blind after treatment. The small sample size in this group limits generalizability, but the trend clearly indicates a poorer outcome compared to closed globe injuries.\u003c/p\u003e\u003cp\u003eThese findings highlight the spectrum of visual outcomes and reinforce the need for preventive strategies during festivals involving firecrackers. Earlier studies have similarly emphasized the value of public education and stricter regulation of firecracker use to prevent such avoidable vision loss [6,8].\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study provides valuable insight into the clinical profile, pattern, and visual outcomes of firecracker-related ocular injuries during the Diwali festival. The predominance of young males among the affected population echoes previous findings in similar Indian studies, underscoring the high-risk nature of this demographic during festive seasons involving fireworks [1,2]. Notably, nearly 40% of the victims were passive bystanders, reaffirming the fact that not only users but also observers are vulnerable to firecracker injuries [6].\u003c/p\u003e\u003cp\u003eThe majority of patients presented with closed globe injuries, which aligns with earlier reports emphasizing their prevalence in firecracker-related trauma [4,5]. Our study reaffirms the generally favorable visual prognosis in these cases, with significant improvement in post-treatment visual acuity. In contrast, eyes with open globe injuries showed minimal recovery, highlighting the devastating potential of such injuries and the importance of early surgical intervention and long-term rehabilitation [4,7].\u003c/p\u003e\u003cp\u003eA considerable proportion of patients presented with mild to moderate visual impairment at baseline, and many experienced substantial visual recovery following timely intervention. While 17.1% of blind eyes showed improvement to normal vision, statistical analysis did not find a significant correlation between presenting and final vision status, likely due to the small sample size in non-normal vision categories. Nevertheless, these improvements reflect the benefits of standardized management protocols and early treatment.\u003c/p\u003e\u003cp\u003eOur findings underscore the importance of preventive strategies, particularly public awareness and education. The role of schools, community programs, and media campaigns in spreading awareness about firecracker safety is crucial. Implementation of safety regulations and strict quality control in firecracker manufacturing can play a vital role in reducing the burden of ocular injuries [6,8].\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eFirecracker-related ocular injuries remain a significant cause of preventable visual morbidity, particularly during festive seasons like Diwali. This study demonstrates that while most cases involve closed globe injuries with favorable outcomes, open globe injuries continue to result in poor visual prognosis. A considerable proportion of those injured are bystanders, emphasizing the broader community risk. Timely intervention can lead to significant visual recovery, but prevention remains the cornerstone. Enhanced public education, stricter regulatory measures, and targeted safety campaigns are essential to reduce the incidence and severity of such injuries\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eDeclaration of Conflicting Interest\u003c/strong\u003e-\u003c/p\u003e\n\u003cp\u003eThe authors declare that there are no conflicts of interest related to this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Statement\u003c/strong\u003e-This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval and Informed Consent-\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Institutional Ethics Committee of Aravind Eye Hospital, Madurai, Tamil Nadu, India, and adhered to the tenets of the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003eWritten informed consent for treatment and inclusion of anonymized data in research was obtained from all participants (or their legal guardians, when applicable).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement\u003c/strong\u003e-The datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e- The authors gratefully acknowledge the support of the Department of \u0026nbsp; orbit and oculoplastic services, Aravind Eye Hospital, Madurai, for facilitating data retrieval and patient follow-up during the course of this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trail number : Not applicable\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSingh DV, Sharma N, Sinha R, Tandon R. Firecracker eye injuries during Diwali festival: A common but preventable cause of ocular morbidity. Indian J Ophthalmol. 2016;64(7):521\u0026ndash;523.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRam J, Sukhija J, Bandyopadhyay S, et al. Firecracker injuries during Diwali festival: The epidemiology and impact on vision. Indian J Ophthalmol. 2015;63(12):946\u0026ndash;949.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. Change the Definition of Blindness [Internet]. Geneva: WHO; 2008.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKuhn F, Morris R, Witherspoon CD, et al. A standardized classification of ocular trauma. Ophthalmology. 1996;103(2):240\u0026ndash;243.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAgrawal R, Rao G. Firecracker injuries: A common cause of ocular trauma in India. Int J Inj Contr Saf Promot. 2006;13(3):129\u0026ndash;132.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDhir SP, Chawla TN. Firework injuries of the eye. Indian J Ophthalmol. 1984;32(5):291\u0026ndash;293.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJain S, Dandona L. Fireworks-related eye injuries in children: The Indian perspective. Eye (Lond). 2007;21(7):865\u0026ndash;866.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDandona R, Dandona L. Ocular trauma in an urban population in southern India: The Andhra Pradesh Eye Disease Study. Clin Experiment Ophthalmol. 2003;31(5):395\u0026ndash;401.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Firecracker injury, ocular trauma, visual impairment, open globe injury, Diwali-related eye injuries, BETTS classification, preventive ophthalmology","lastPublishedDoi":"10.21203/rs.3.rs-8027798/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8027798/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003ePurpose\u003c/b\u003e\u003c/p\u003e\u003cp\u003eTo analyze the demographics, types of ocular injuries, management strategies, and visual outcomes in patients presenting with firecracker-related ocular trauma.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis multicentric prospective study included 254 patients who presented to the emergency and outpatient departments during the Diwali festival in 2023.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAmong the 254 patients, 198 (77.9%) were male with a mean age of 19.76\u0026thinsp;\u0026plusmn;\u0026thinsp;15.34 years. Unilateral involvement was seen in 211 patients (83.3%) The most common presenting complaint was defective vision (32%). 153 patients were active ignitors, while 99 (38.97%) were passive bystanders. Based on WHO guidelines, 198 patients (69.2%) had mild visual impairment at presentation, while 41 (14.3%) presented with blindness. According to the Birmingham Eye Trauma Terminology System (BETTS), 95.9% had closed globe injuries and 4.1% had open globe injuries.\u003c/p\u003e\u003cp\u003e\u003cb\u003eDiscussion\u003c/b\u003e\u003c/p\u003e\u003cp\u003eOcular injuries caused by firecrackers can range from minor abrasions to devastating globe ruptures. The majority of the cases were young males, consistent with previous studies [1,2]. The high proportion of bystanders among the injured highlights the need for broader public awareness and control measures [3]. Most patients responded well to conservative management. However, open globe injuries and cases presenting with severe visual impairment or blindness had limited visual recovery.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e\u003cp\u003eFirecracker-related ocular trauma presented with a wide range of injuries, from minor burns to globe rupture, requiring varied treatment approaches. Unlike previous studies, over one-third of the affected individuals in our cohort were bystanders. Poorer outcomes were associated with severe visual impairment, blindness, and open globe injuries.\u003c/p\u003e","manuscriptTitle":"Clinical Profile, Pattern of Injuries, and Visual Outcome Following Firecracker-Related Ocular Injury","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-21 01:12:42","doi":"10.21203/rs.3.rs-8027798/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b0123d62-b350-4247-a026-c120004aff2f","owner":[],"postedDate":"November 21st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-29T03:53:27+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-21 01:12:42","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8027798","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8027798","identity":"rs-8027798","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}