Nothing says summer like Fourth of July family barbecues, beach gatherings, trips to a favorite amusement park, and fireworks. Many of these gatherings on our nation’s birthday conclude with a fireworks display, with most as spectators and others as active participants. But just how safe are fireworks in terms of overall injuries and specifically ocular injuries and what precautions can be taken in order to avoid an uninvited Independence Day disruption? Eyecare professionals can play a critical role in knowing about what can happen and making sure to warn patients and parents about some of the dangers.

According to the Consumer Product Safety Commission (CPSC), fireworks devices were involved in an estimated 10,200 injuries treated in U.S. hospital emergency departments during calendar year 2022. And, there were 11 non-occupational, fireworks-related deaths during that time period.

Furthermore, the CPSC report states that 16 percent of fireworks injuries were to the eyes. According to the American Academy of Ophthalmology (AAO), in the most severe cases, fireworks can rupture the globe of the eye, cause chemical and thermal burns, corneal abrasions and retinal detachment—all of which can cause permanent eye damage and vision loss. These injuries were seen in both adults and children.

Thomas L. Steinemann, MD

VM spoke with Thomas L. Steinemann, MD, MetroHealth Medical Center, and professor of ophthalmology, Case Western Reserve University, and Loretta Szczotka-Flynn OD, PhD, Philip F. and Elizabeth G. Searle - Suber Huang professor in the department of ophthalmology & visual sciences at Case Western Reserve University with a secondary appointment in the department of population & quantitative health sciences, about the real dangers of fireworks usage and viewing both among adults and children.

“Never allow young children to use fireworks,” said Dr. Steinemann. “Even ‘sparklers’ burn at very high temperatures and can rapidly cause thermal burns. Do not allow running or horseplay and provide eye protection, of course.”

Loretta Szczotka-Flynn OD, PhD

Dr. Szczotka-Flynn added, “Children are more commonly bystanders than active users of fireworks compared with adults in severe firework-related injuries, and in fact the American Academy of Pediatrics reported that ocular injuries constitute 20 percent of all firework-related injuries. Therefore, precautions are key. Bystanders should abide by barriers and make a point to watch professional firework displays instead of using consumer fireworks. No one should ever pick up a misfire, and supervise all children even with sparklers. If you are engaging in consumer fireworks in states where it is legal, wear proper eye protection – this means eyewear that meets ANSI standards for safety glasses.”

According to the American Pyrotechnics Association, 49 states plus the District of Columbia allow some or all types of consumer fireworks. Illinois and Vermont allow only wire or wood stick sparklers and other novelty items. Massachusetts bans all consumer fireworks.

According to the AAO, most fireworks deaths result from unsafe handling. But even correct use can kill or injure well-meaning and safety-minded people. Fireworks can misfire, discharge in the wrong direction or ignite all at once in a massive, uncontrollable explosion. Even legally purchased fireworks can have unsafe—even illegal—contents. This can cause fireworks to malfunction and kill or injure people nearby, despite proper handling.

When igniting “consumer” fireworks, Dr. Steinemann recommends doing so outdoors only in a clear area, and never re-light, handle or toss “duds”. And never ignite in glass or metal containers. As for volatile “rockets”, he also stresses the importance of finding a clear area.

“As many as 65 percent of injuries happen to spectators and innocent bystanders, and many of these are young children in ‘harm’s way.’ Children aged 15 and younger account for one-third of total injuries. Fireworks caused nine deaths and 11,500 injuries in 2021,” he continued. “Fifteen percent of these injuries were to the eyes and 16 percent to the face. Many fireworks can have flaws/banned chemicals in the explosive mix, faulty or modified fuses, sometimes leading to misfiring.”

Some of the more common eye injuries related to fireworks use, according to Dr. Steinemann, include eyelid lacerations and burns, ocular surface chemical and thermal burns, corneal lacerations, internal bleeding, globe rupture, and even loss of an eye. “Many victims require consultation/conjoint/multiple surgeries with help from trauma and plastic surgeons to rebuild the face and eyelids. Injured eyes can often develop cataracts and glaucoma requiring later surgery,” he said.

If these types of injuries occur, Dr. Steinemann has a short list of do’s and don'ts to follow: “For burns, foreign bodies, or liquids, immediately flush with water. Seek immediate help by going to the emergency room or to an ophthalmologist. Do not rub the injured eye; cover it with a ‘shield’: this can be fashioned by taping the bottom of a Styrofoam cup over the eye to prevent touching/rubbing, etc. And never try to pick any debris out of the eye.”

Dr. Szczotka-Flynn added, “Such injuries are truly ocular emergencies, most patients will find themselves in an emergency room. They should call 911 and seek assistance immediately. Because an open globe injury is possible, all immediate injuries should be protected with an eye shield. ERs are prepped to manage more of such cases around the Fourth of July holiday. Local doctors certainly can be called but if time is of the essence ERs will be better equipped.”

Education provided by eyecare professionals, both MDs and ODs alike, can play a major role in eye safety during the summer season.

“Everyone should educate and disseminate infographics on their social media channels with the same prevention messages,” said Dr. Szczotka-Flynn, pointing to messages at Prevent Blindness and the American Academy of Ophthalmology.

“We, as eyecare professionals know that the gift of sight is precious, that the eye is vulnerable, and that prevention is the key,” Dr. Steinemann said. “These injuries are so avoidable and so tragic at any age, but especially among young people and children.”

In addition to educating the public, Dr. Steinemann stressed that educating legislators is also key. “I sense in recent years that our message is falling on deaf ears as far as lessening fireworks legal restrictions.”

Most fireworks eye injuries happen between mid-June and mid-July, according to Dr. Steinemann, who’s message of eye safety and fireworks is simple: “Have a happy and safe July 4th holiday and leave the pyrotechnics to professionals!”

Fireworks by the Numbers: The Consumer Product Safety Commission Report

The Consumer Product Safety Commission’s (CPSC) issued its 2022 fireworks annual report just in time for this year’s extended Fourth of July holiday weekend. Here are a few takeaways from the new report:

• Fireworks were involved with an estimated 10,200 injuries treated in U.S. hospital emergency departments during calendar year 2022.

• There is a statistically significant trend in estimated emergency department-treated, fireworks-related injuries from 2007 through 2022. This trend estimates an increase of 535 fireworks injuries per year.

• An estimated 7,400 fireworks-related injuries (or 73 percent of the total estimated fireworks-related injuries in 2022) were treated in U.S. hospital emergency departments during the 1-month special study period between June 17, 2022, and July 17, 2022.

• Adults 25 to 44 years of age experienced about 36 percent of the estimated injuries, and children younger than 15 years of age accounted for 28 percent of the estimated injuries.

• Victims 15 to 19 years of age had the highest estimated rate of emergency department treated, fireworks-related injuries (6.0 injuries per 100,000 people). Children, 10 to 14 years of age, had the second highest estimated rate.
• The parts of the body most often injured were hands and fingers (an estimated 29 percent); head, face, and ears (an estimated 19 percent); legs (an estimated 19 percent); eyes (an estimated 16 percent); trunk/other regions (an estimated 12 percent); and arms (an estimated 5 percent).

• Find out more fireworks safety at