Aim To provide a systematic review on ocular firework trauma with emphasis on incidence and patient demographics, the extent of ocular trauma and visual function loss, and firework regulation effects on injury rates.

Methods A literature search was performed using predetermined inclusion and exclusion criteria. Demographic characteristics of ocular firework casualties were obtained and incidence rates of sustained trauma and vision loss calculated.

Results Twenty-six relevant articles were suitable for calculation of trauma incidence and patient demographics, of which 17 articles could be used for calculating trauma severity and vision loss. Victims were male (77%), young (82%) and often bystander (47%). Most of the trauma was mild and temporary. Penetrating eye trauma, globe contusions and burns accounted for 18.2%, with a 3.9% enucleation rate. Mean visual acuity was >10/20 in 56.8%, with severe vision loss (<10/200) in 16.4%. Countries using restrictive firework legislation show 87% less eye trauma (p<0.005).

Conclusions One in six ocular firework traumas show severe vision loss, mostly in young males. Bystanders are as frequently injured. Firework traumas are a preventable cause of severe ocular injury and blindness because countries using restrictive firework legislation have remarkable lower trauma incidence rates.