Joy or tragedy: firecracker-inflicted traumatic optic neuropathy

Abstract

Background: Firecrackers are traditionally used as part of celebrations. However, they lead to significant ocular injuries. Traumatic optic neuropathy (TON) is among the blinding conditions caused by firecrackers, although it is either uncommon or under-reported.

Case presentation: During Hari Raya Aidilfitri 2022, a 4-year-old boy and a 29-year-old gentleman presented with blast injury by firecrackers. Visual acuity at presentation was hand movement and light perception (LP), respectively, both with marked relative afferent pupillary defect. Both patients were diagnosed with TON and
were treated with high-dose intravenous methylprednisolone for 3 days. However, their visual recovery remained poor after treatment completion. One-month post-trauma, their best-corrected visual acuity was counting fingers and LP, respectively.

Conclusion: TON due to firecracker injury is potentially blinding and has poor visual outcomes with current treatment modalities. Awareness among the public and strict law enforcement is necessary to bring down the incidence of firecracker-related ocular morbidity and blindness.