Traumatic Endothelial Rings After Firework Debris

Purpose of this report is to describe a rare case of traumatic endothelial rings in a pediatric patient following ocular injury from firework explosion debris. This report highlights the clinical presentation, diagnostic findings, and management considerations for this uncommon form of corneal endothelial trauma. Given the potential for long-term visual impairment, we emphasize the importance of early ophthalmologic intervention, careful monitoring, and appropriate treatment strategies. Additionally, this case underscores the need for stricter firework safety measures to prevent similar ocular injuries.

Department of Ophthalmology, University hospital center Zagreb, Zagreb, Croatia

A 14-year-old boy presented to our ER with redness and a foreign body sensation in his left eye after being struck by debris from an exploding firework the night before.

His visual acuity was 1.0 in the right eye and 0.8 in the left. There were small punctate abrasions with embedded foreign bodies on both sides of his face, predominantly on the left.

Slit-lamp examination revealed a normal status of the right eye, while the left showed conjunctival irritation, corneal foreign bodies with numular endothelial opacities underneath and anterior chamber with big floating cells. Pentacam measured corneal edema at 648 µm, and specular microscopy showed endothelial cell loss (1537 cells/mm²). Foreign bodies were removed and scopolamine was instilled. The patient was prescribed antibiotic drops and ointment, artificial tears and corneal moisturizing gel.

At the one-week follow-up, his symptoms had improved and left eye visual acuity had recovered to 1.0. The conjunctiva was clear, numular endothelial opacities were still present but reduced and anterior chamber cells had diminished. Pentacam showed corneal edema regression (568 µm), while specular microscopy remained unchanged. Therapy was adjusted to include mild corticosteroid drops for 10 days, hyperosmolar artificial tears and continued lubrication. The patient did not show up for check-up, only reported by phone that he was asymptomatic.

Traumatic endothelial rings are a rare consequence of high speed small object ocular injuries and may indicate long-term endothelial damage. Although the patient’s vision recovered well, endothelial cell loss and residual numular blurring highlight the need for long-term monitoring, as they may impact future ocular procedures such as cataract surgery. This case shows the importance of early intervention, regular follow-ups and most importantly, the necessity of wearing protective eyewear to prevent similar injuries.