Purpose

To present a multicentre case series of severe firework-related ocular and periocular injuries in adolescents, highlighting the visual, reconstructive, and psychological sequelae of these preventable events.

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Methods

Retrospective case review of five patients aged 14-18 years, who presented with firework-related ocular trauma at two tertiary trauma centres in the UK between 2024 and 2025. Data included injury pattern, surgical management, and outcomes involving the globe, ocular surface, eyelids, and anophthalmic socket.

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Results

Three patients sustained open-globe injuries, all resulted in a final visual acuity of no perception of light (NPL). One patient progressed to phthisis bulbi following primary repair and subsequently underwent rehabilitation with a scleral shell prosthesis. Another patient sustained bilateral globe rupture with intraocular foreign bodies; one eye required primary evisceration and the fellow eye underwent vitreoretinal surgery, resulting in bilateral NPL. A third required evisceration for extensive corneal destruction and underwent multiple failed socket reconstructions precluding prosthetic fitting.

Two patients sustained severe thermal ocular surface burns without globe rupture, and one had associated eyelid lacerations. Both required surface reconstruction with mucous membrane grafting or limbal stem cell transplantation, and developed long-term adnexal morbidity, although visual acuity was moderately preserved.

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Conclusion

Firework-related ocular trauma in adolescents results in catastrophic, lifelong morbidity, including blindness (3/5 NPL), loss of the eye (2/5 evisceration), complex socket disease, and psychological burden. Even within tertiary centres, outcomes remain poor. These findings emphasise the urgent need for strengthened public health measures and prevention strategies to reduce these avoidable injuries.

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Additional Authors

First name	Last name	Base Hospital / Institution
Lyudmila	Kishikova	James Cook University Hospital, United Kingdom
Holly	Duncan	Royal Victoria Infirmary, United Kingdom
Romeela	Rana-Rahman	Royal Victoria Infirmary, United Kingdom
Gar-Yun	Wong	James Cook University Hospital, United Kingdom
Andrew	Gibson	James Cook University Hospital, United Kingdom

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