'Up to half of fireworks victims are bystanders and they are often children'

[caption id="attachment_7390" align="alignnone" width="750"] Marjolijn Bartels[/caption] Fireworks were responsible for 19 blinded eyes on New Year’s Eve 2016 in The Netherlands. The igniting of fireworks to usher in the New Year is a strong tradition among the Dutch, leading to severe ocular trauma on a yearly basis. Marjolijn Bartels MD, Deventer Hospital, The Netherlands, shared her clinical experience with the management of fireworks trauma with delegates attending the ESCRS/EuCornea Cornea Day in Maastricht, The Netherlands. “Up to 50% of victims are bystanders, and they are often children,” said Dr Bartels. “Limbal ischaemia causes profound and permanent limbal stem cell loss, which prevents re-epithelialisation of the corneal epithelium,” Dr Bartels noted. After initial surgical treatment to remove gun powder from the fornices, topical treatment includes steroids, antibiotics and atropine. “Oral treatment should include doxycycline and ascorbic acid (vitamin C), which is an important factor for wound healing and corneal stromal repair,” she said. Necrotic tissue excision and amniotic membrane transplantation were necessary to prevent further symblepharon formation. Despite optimal treatment, epithelial defects often take several months to close completely. Dr Bartels then described the long-term management of limbal stem cell deficiency, with a particular focus on cultivated limbal epithelial transplantation (CLET), which requires only very limited harvesting of the normal eye’s limbal cells for culture in vivo. “This allows us to avoid risking damaging the healthy eye with a conjunctival limbal autograft, a risk which monophthalmic patients are clearly eager to avoid,” said Dr Bartels.