How do I put somebody's eye out?
April 25, 2016 1:13 PM   Subscribe

Asking for fiction: I would like to stage a FICTIONAL eye-related accident that involves a person falling into one of those fireworks that is a fountain of sparks. Let's say the person falling on the firework is 5'8" and the firework is at table height. The person trips and falls and gets the firework to the face. What sorts of physiological damage are we looking at?

posted by angrycat to Grab Bag (9 answers total) 3 users marked this as a favorite
If you want an introduction to my friend Pyroboy who has seen basically every single firework related accident there is, drop me an email.
posted by jessamyn at 1:20 PM on April 25, 2016 [5 favorites]

I think eye related incidents are often caused by roman candles.
The kind of fireworks that are BIG fountains? Like the ones that can be seen from the whole neighborhood?
I know someone that leaned over one at his family party; he thought it was a dud, it exploded and he died. It was a pretty large one, but not TOO crazy since it is illegal here.
posted by beccaj at 1:31 PM on April 25, 2016 [1 favorite]

edit: I said roman candle but I think I meant bottle rocket!

"19 percent, or 1,200, of those injuries were to the eyes. Sparklers accounted for 1,400 injuries, firecrackers (1,400) and bottle rockets (100)."
posted by beccaj at 1:33 PM on April 25, 2016 [1 favorite]

If the fireworks do not penetrate the cornea then a scratched cornea seems likely. Penetration of the eyeball itself is an ocular penetration. If the eyeball comes out of socket that is an ocular evulsion.

More likely is scratches to the cornea, burns to the face and eyelids, and a detached retina.

"Don't ask me how I know"
posted by pdoege at 2:45 PM on April 25, 2016 [1 favorite]

Does the character NEED to bend over the fireworks? How about just standing too near and getting smacked in the eye by a flying bit of debris?
posted by easily confused at 3:28 PM on April 25, 2016

are you trying to stage this for an audience, or write about it plausibly?
posted by cubby at 5:57 PM on April 25, 2016

FIRST: A fountain is an unlikely culprit. Although fireworks and children are a recipe for mono-ocular trauma, the most likely culprits are the small firecrackers, bottle rockets and sparkles. The common theme is they are devices that will likely be hand held at some point shortly before or during ignition. The reflexes to protect your face and eyes (while fairly useless against fast moving projectiles like BB's, airborne debris or flying shrapnel from a catastrophic powertool failure) usually trigger well enough during any fall. Possibly this is a reason why the relatively stationary fountains cause relatively few of the injuries that are reported in emergency room surveys. If circumstances require it to be a fountain (either FX limitations / logistical challenges of a stage show or some deeply ingrained story elements), then you need to do something to incapacitate the victim. Either he is fall-down-drunk, suffering a seizure or falling after a blow to head rendered him unconscious. Unfortunately, this is likely something non-medical people in your audience will notice; its hard to convincingly portray an alert person falling onto a fountain without closing his eyelids, turning his head or covering his face with outstretched arms. These are all reflexes that are present before a child starts walking, and people who fall without doing them look "off."

SECOND: The injury is going to be very dependent on the physics of how the way the firework mets the eye. Depending on the population studied, open globe injuries (a hole in the sclera/cornea allow the liquid inside to get out or a foreign body penetrating into the chambers of the eye) or closed globe only injuries (sclera, conjuntiva or corneal get burns, tears and scars) are both roughly equally likely to occur. It all depends largely on the kinetic energy of the firework and how the energy is absorbed by the eye. Sparklers can both penetrate or not depending on the pointy end or the long side contacting the eye. Most individual flying sparks, while very hot, are small enough that they will cause more superficial, less severe trauma (usually grain sized corneal abrasions). A larger ember with a longer burn time can cause more damage. I would expect a fountain to more likely cause superficial damage, the majority of which is limited to an area where the tissues comes into direct contact with the outlet of the sparks from the fountain.

THIRD: Physiologically, the penetration from the debris and the burns are causing the immediate damage, with inflammation/swelling after the event playing a major role for vision loss for some small segment of the closed globe injuries. According to a cadaver study from 2012 published in JAMA, the blast pressure from a firecracker is way too small to produce significant trauma. The trauma may not be immediately painful given the relative dearth of pain nerve fibers in some layers of the globe, and the nerve fiber's susceptibility to injury, but pretty much any adjacent structure will suffer severe inflammation and contain a metric shit-ton of pain nerve receptors, very soon causing severe pain. In any type of injury, bleeding into the vitreous in front of the retina or the chamber in front of the lens is likely. Intraocular pressure can rise, causing pain, or not, but likely causing some damage as well. If the retina isn't scarred or torn directly by the trauma, edema causing retinal detachment may not be far behind. The iris is held in tension by ciliary muscles surrounding its circumference, an injury involving the structures the ciliary muscles are attached to can cause the iris to avulse outwards from the pupils (sometimes exiting the eye partially through a defect in open globe injury) given the pupil a misshapen appearance that is not dissimilar to a broken egg yolk.

The extent of the trauma (especial open versus closed globe) and the visual acuity immediately after the accident are the best predictors of the amount vision loss likely to be suffered by the victim. Just about any structure that is involved in sight can be damaged in a firework injury so the specific, proximal pathophysiological cause of the loss of visual acuity runs the gamut. Cataracts, retinal necrosis, infection, loss of refractive power due to enucleation or loss of the lens are all on the table here.
posted by midmarch snowman at 11:21 PM on April 25, 2016 [3 favorites]

Go to PubMed and look up Fireworks accident. You can also specify "Case Reports" as well as "Free Full Text." (somewhere on the left hand column, you might have to expand some of those tabs)

Many of these case reports may contain graphic images, as well as a thorough discussion on how the injury occurred, what the injuries were, and typically, how the injuries resolved/healed.
posted by porpoise at 11:47 AM on April 26, 2016

Thanks everyone, so much! I had some good results with my prior question about how I might fictionally kill somebody, so I am very excited to receive more metafilter wisdom.
posted by angrycat at 1:30 PM on April 27, 2016

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