Eye Injury from a Firecracker
Parul C. Gupta, M.S., and Jagat Ram, M.S.
June 29, 2017
N Engl J Med 2017; 376:2579
A 44-year-old man presented to the emergency department with pain and decreased vision in both eyes after an injury sustained while lighting a firecracker. He was unable to perceive light in the right eye and had reduced visual acuity of 20/80 in the left eye. He received a diagnosis of globe rupture in the right eye. Slit-lamp examination of the left eye revealed multiple foreign bodies embedded at superficial and deep levels in the corneal stroma (Panel A). Axial computed tomographic scans of both orbits showed multiple intraocular foreign bodies (Panel B, arrows). Intraocular foreign bodies can occur as a result of high-velocity injuries, such as those caused by firecrackers, gunshots, or industrial accidents. The use of appropriate eyewear may be protective. The foreign bodies were removed from the cornea, and the patient was treated with topical antibiotic agents and lubricating eyedrops. During the next 3 months, visual acuity in the left eye improved to 20/40. Despite treatment of the right eye that included primary surgical repair, this eye remained nonfunctional, or in a state often referred to as phthisis bulbi — end-stage disease characterized by shrinkage of the eye.