Firework eye injuries: the question that is not on the referral form

Eighty-one per cent of the serious firework eye injuries reported to the British Ophthalmological Surveillance Unit happened in October and November. In 2026 the two nights that fill those months are three days apart: Bonfire Night on Thursday 5 November, Diwali on Sunday the 8th.

The BOSU study ran for two years from July 2004. Every ophthalmologist in the UK was sent a card each month and asked to report any new serious firework eye injury, or to confirm there had been none. Forty-seven cases came back. Twenty-six per cent had a penetrating injury. Fifty-three per cent needed ocular surgery. Eight patients, 17%, lost the eye to enucleation or evisceration, and four more needed a cosmetic shell for phthisis. At six months, 53% of those followed up were 6/60 or worse. Twenty-seven per cent were under 18.

That is the national picture and it is twenty years old. A study published this August adds the one number the UK data never had.

Six hours

A multicentre prospective study followed 67 consecutive patients with firecracker eye injuries through the Diwali periods of 2023 and 2024, at three tertiary centres in Central and Western India. Children were 62.7% of them and males 89.6%. Two-thirds, 65.7%, were handling the firework themselves; the other 34.3% were watching. Blast was the mechanism in 80.6% and 82.1% of the injuries were closed-globe. More than 40% presented with acuity worse than 6/60 and 23.9% needed surgery.

The median time from injury to presentation was six hours.

Only the abstract is published. The paper is ahead of print and not deposited anywhere open, so nothing above goes further than what the abstract states.

What fills the six hours

Nobody sits for six hours with an injured eye doing nothing.

A population-based survey interviewed 2,160 adults across 25 rural clusters in Haryana and asked, among other things, what they put in their eyes. Of the 2,055 asked about home remedies, 529 (25.7%) had used one. Kajal accounted for 61.4% of those, honey 31.4%, ghee 11.7% and rose water 9.1%.

The number that matters here is smaller and more specific. Eighty-five of the people interviewed had sustained an ocular injury. Fourteen of them, 16.4%, had used a traditional eye medicine for it. Thirty-five, 41.2%, had sought no treatment at all.

The authors' argument is not that kajal is exotic. It is that the harm runs through two ordinary mechanisms: contamination of a surface that is already broken, and the delay that comes from trying something first.

The limitations of the firework eye injury evidence

That survey was done in rural North India and published in 2017, in a population with a mean age of 55.6 where two-thirds had primary schooling or less. It does not describe a UK high street. I could not find a survey of what patients here put in an injured eye before they arrive, and that is the honest gap in this piece.

What transfers is the shape of the behaviour rather than the contents of the cupboard. Reaching for something at home before reaching for a professional is not a regional habit, and the two mechanisms do not care what was reached for. The pathway argument is the same one Denmark's high street OCT data made from the other end: what the high street can see matters less than what happens next.

Why it matters in practice

• Ask what has already gone in the eye. Ask it of everyone, in the same words, before you ask anything else, and ask it without a face that makes the answer harder to give.
• Time is the variable you can change. Six hours was the median in a series where more than 40% arrived worse than 6/60; the delay is the mechanism, not the remedy on its own.
• A quiet eye is not a reassuring one. Closed-globe injuries were 82.1% of the Diwali series, and a closed globe is what walks into a practice rather than an eye casualty.
• A third of them were bystanders. 34.3% of that series were watching, not handling, which is worth remembering before the history starts with what they were doing.

Sources

1. 1.Firecracker-related ocular injuries during the Diwali festival: A multicentric prospective study from Central and Western India · Indian Journal of Ophthalmology, 24 August 2026
2. 2.Use of traditional eye medicine and self-medication in rural India: a population-based study · PLOS ONE, 24 August 2017
3. 3.A British Ophthalmological Surveillance Unit study on serious ocular injuries from fireworks in the UK · Eye, 9 March 2007