Firework-related Ocular Injuries: A Systematic Review and Meta-analysis of Clinical Outcomes and Preventive Strategies

Firework-related ocular injuries present a critical global public health issue, with incidence spikes during festivals and celebrations. Despite preventive efforts, these injuries continue to contribute significantly to preventable blindness, long-term visual impairment, and healthcare burdens worldwide. This systematic review and meta-analysis assess published studies on firework-related ocular injuries, examining demographic distribution, injury types, clinical outcomes, and the effectiveness of preventive measures. A thorough search of PubMed, Scopus, and Web of Science databases was conducted, focusing on studies from 2000 to 2023 with at least 30 patients. Data extraction and synthesis were performed independently by two reviewers, and a meta-analysis using a random-effects model was applied. Outcomes were measured in odds ratios (ORs) with 95% confidence intervals (CIs), while heterogeneity was assessed using the I ² statistic. Of 2040 articles screened, 15 met the inclusion criteria, covering a total of 2500 patients. Males made up 85% of cases, with 30% of injuries occurring in individuals under 20. Common injuries included corneal abrasions (48%), hyphema (23%), and globe ruptures (12%). Meta-analysis revealed that 80% of patients attained a best-corrected visual acuity (BCVA) of 6/18 or better posttreatment (OR = 0.80, 95% CI: 0.66–0.93, P < 0.05), though 15% retained a BCVA worse than 6/60, especially those with globe ruptures. Preventive measures, such as protective eyewear and safety education, significantly lowered injury rates (OR = 0.65, 95% CI: 0.45–0.89, P < 0.01) with moderate heterogeneity ( I ² =56%). The results highlight the urgent need for mandatory protective eyewear, awareness campaigns, and collaborative safety initiatives to reduce firework-related ocular trauma.