although the use of homemade fireworks is banned by legislation in china , juvenile eye injuries from illegal homemade fireworks occur especially in the countryside . few studies in the international literature have focused on homemade firework - related injuries . in the us , during june to july 2002 , approximately 300 ( 5.3% ) of the patients with firework - related injuries were injured in incidents involving illegal and homemade fireworks in the 17 participating states in a study by the centers for disease control and prevention . most of them happened in iran during the annual last wednesday of the year festival ( charshanbeh soori ) , and homemade grenades were the most frequent type of fireworks causing injury . the severity of injuries varied greatly , and orbital foreign bodies may be difficult to diagnose clinically and radiologically due to the complicated composition of the homemade fireworks . reliable imaging information is necessary to elucidate emergent injuries , to preoperatively plan the reconstruction of functional areas , and to guide the physical rehabilitation process . computed tomography ( ct ) scan is considered the gold standard imaging technique for acute iron - containing orbital foreign bodies . however , ct findings can be variable ; to avoid missing the diagnosis , careful follow - up is needed . herein , we report a rare case of traumatic injury to the eye from homemade fireworks in a chinese juvenile patient with a metal ring left in the orbit after having been sutured at the emergency department . an 11-year - old boy presented with a traumatic injury to the right eye from homemade fireworks . following initial assessment involving maxillofacial ct and suturing at the emergency department , he was transferred to our department for further evaluation because of his poor sight 1 day later . on examination , it was noted that several superficial wounds had been sutured before the child presented to us . his vision was limited to light perception , and the intraocular pressure was 21 mm hg . a skin laceration beneath the right eyebrow was noted , but the superior orbit was not fully visible on the maxillofacial ct performed 1 day previously . therefore , an orbital ct scan was carried out on the second day , which again showed a hyperdense ring ( fig . 1a , arrow ) ; this magnetic metal ring , measuring 18  12 mm and embedded in the superior border of the orbital wall , was surgically removed ( fig . 1b , c ) . on postoperative day 7 , the blood clot in the anterior chamber had decreased in size , and a 1-mm - layered hyphema was present . a fundus examination revealed resolving vitreous hemorrhage , retinal hemorrhage ( fig . 1d , short arrow ) , blunt traumatic retinal detachment superior to the macula ( fig . 1d , long arrow ) , and a large retinal tear parallel to the corneoscleral limbus located in the nasal superior fundus quadrant . therefore , we opted for starting on oral steroids for 1 month and careful observation . after 2 months ' observation , discrete areas of retinal pigment epithelial hypertrophy and atrophy , retinal hemorrhage , and epiretinal membrane formation ( fig . 1e , short arrow ) the large retinal tear had healed and white fibrous scar tissue had developed ( fig . 1e , long arrow ) , and the retinal detachment superior to the macula had reattached itself spontaneously . his vision had further improved to 20/200 . during 1 year of follow - up , he remained clinically stable . because of the complicated composition of homemade fireworks , the severity of injuries varies greatly . the first clinical and radiographic examination of the traumatized patient is crucial to determine the initial diagnosis , the severity of the injury , and a treatment plan as well as to create a baseline for follow - up . in the case of a patient who has undergone maxillofacial injury or orbital trauma associated with homemade fireworks , complete history taking and on suspicion of an iron - containing foreign body , an imaging study such as ct must be performed . however , because ct findings can be variable , exploratory surgery over the suspected area and careful follow - up is needed . a ct scan of the orbit helps to better delineate the location of the foreign body and its relation to the surrounding bony and parenchymal structures in an emergency situation . in this case , the initial maxillofacial ct did not show the foreign body in the orbit , because the scan region was not large enough . thus , in the event of maxillofacial injury , especially with skin lacerations beneath the eyebrow , a ct scan of the orbit is useful to detect the foreign body in the orbit and to avoid misdiagnosis . ocular toxicity of an iron - containing foreign body that is retained and even located in the orbit after an injury may produce ocular siderosis and severe progressive visual loss . studied the penetration of iron and found that iron passes from the orbit into the eyeball and accumulates in considerable quantities in the sclera , choroid , retina , ciliary body , and even in the vitreous and corneal epithelium . clinical manifestations include a rust - colored corneal stroma , heterochromia iridis , pupillary mydriasis , uveitis , cataract , lens subluxation , secondary glaucoma , and retinal degeneration . the electroretinogram may be normal or hypernormal early in the disease process , but it gradually decreases in amplitude as the disease progresses . therefore , an exploratory surgery over the suspected area and complete removal of the foreign body by the emergency physician is necessary before the wounds have been sutured . the management of juvenile traumatic retinal detachment is still challenging for ophthalmic surgeons . the functional and anatomic outcomes of retinal detachment in children are less successful than in adults . advanced proliferative vitreoretinopathy ( pvr ) as a surgical outcome in juvenile retinal detachment is more frequent than in adults . the frequency of advanced pvr in juvenile patients was 37.5% in a study by akabane et al .   and 29.8% in a study by delage and bonnet . the reasons for the more frequent association of advanced pvr with juvenile retinal detachment may be not only a delayed diagnosis and prolonged retinal detachment but also a higher intraocular cellular activity . the frequency of a postoperative visual acuity worse than 20/200 was 3 in the 10 patients younger than 12 years of age in the study by akabane et al . . as evidenced by the current case , nevertheless , spontaneous closure of a retinal tear and retinal reattachment can occur . oral steroids and observation for a period of several months is a management of choice for traumatic retinal detachment and tear superior to the macula associated with homemade fireworks in children . future studies with more cases might further improve our knowledge of this entity . moreover , a strict legislation regarding the domestic use of homemade fireworks should be considered because of the increasing incidence of these injuries . informed consent has been obtained from the subject , and the study protocol has been approved by the institute 's committee on human research . none of the authors have any conflicts of interest regarding the material presented in this paper .
purposewe report a rare case of traumatic injury to the eye caused by homemade fireworks in a chinese juvenile patient with a metal ring left in the orbit after having been sutured at the emergency department.methodsan 11-year - old boy presented with a traumatic injury to the right eye from homemade fireworks . following initial assessment involving maxillofacial computed tomography ( ct ) and suturing at the emergency department , 
 he was transferred to our department for further evaluation because of his poor sight 1 day later . on examination , 
 a skin laceration beneath the right eyebrow was noted , but the superior orbit was not fully visible on the maxillofacial ct performed 1 day previously . 
 therefore , an orbital ct scan was carried out on the second day , which showed a hyperdense ring embedded in the superior border of the orbital wall ; the ring was surgically removed . 
 on postoperative day 7 , a fundus examination revealed resolving vitreous hemorrhage , blunt traumatic retinal detachment , and a large retinal tear superior to the macula . 
 the patient refused to take surgery for retinal detachment into consideration . 
 therefore , we opted for oral steroids and careful observation.resultsafter 2 months observation , the large retinal tear had healed and white fibrous scar tissue had developed , and the retinal detachment superior to the macula had reattached itself spontaneously . the patient 's vision had further improved to 20/200 . during 1 year of follow - up 
 , he remained clinically stable.conclusionto avoid missing the diagnosis , a complete history of the mechanism of injury and accurate imaging still prove most useful . 
 complete removal of the foreign body by the emergency physician is necessary because of the ocular toxicity of an iron - containing foreign body . as evidenced by the current case , oral steroids and observation for a period of several months 
 is a management of choice for traumatic retinal detachment and retinal tear superior to the macula associated with homemade fireworks in children .