First author:Abstract
Purpose:
To describe the clinicodemographic profile, early clinical findings, and short-term outcomes in patients with carbide gun–related ocular trauma.
Methods:
This ambispective study included 37 patients presenting with carbide gun–related ocular trauma at a tertiary eye center over 10 days in October 2025. Demographic data, mechanism of injury, clinical findings, grading of ocular surface burns, adnexal involvement, and management details were recorded. The best-corrected visual acuity (BCVA) and corneal thickness (CT) were assessed at presentation and during follow-up. All patients were managed based on injury severity.
Results:
All patients were male with a median age of 15 years. All injuries occurred at home, predominantly during device inspection after ignition failure. The right eye was involved in 89.2%. Severe burns (Dua’s grade IV–VI) were observed in 64.8%. Deep stromal calcium deposits and corneal edema were common. Early amniotic membrane transplantation (AMT) was performed in 81%. Mean BCVA improved from 2.09 ± 0.79 at presentation to 0.80 ± 0.44 logMAR at 1 week, and mean CT reduced from 798.5 ± 141.9 µm to 537.5 ± 39.7 µm. Early signs of limbal stem cell deficiency (LSCD) were seen in severe burns at 4 weeks. Most eyelid burns healed well with collagen sheet application.
Conclusion:
Carbide gun–related ocular trauma causes severe, vision-threatening thermochemical ocular injuries predominantly in children and adolescents. Early AMT improves short-term outcomes, but severe grade burns carry a high risk of LSCD. Public awareness, regulation of calcium carbide availability, and social media control are needed to prevent avoidable blindness.
Keywords: Calcium carbide, Carbide gun injury, firecrackers, ocular surface burn, thermochemical injury
Ocular trauma with firecrackers continues to be an important cause of ocular injuries during major festivals in India, particularly during Diwali. The severity of these injuries varies from mild conjunctival congestion to permanent visual impairment in 18%–45% of affected eyes.[1,2]
In recent years, the use of locally made carbide guns has emerged as an alarming addition, particularly among children and adolescents. It is a novel firecracker device made with a polyvinyl chloride (PVC) plastic pipe using calcium carbide (CaC2) as a propellant. CaC2 is widely available in the market and is sold with minimal regulatory control.[3] In the gun, CaC2 reacts with water and is ignited using a domestic gas-stove lighter, producing an explosive flame and loud sound. These carbide guns are inexpensive but can generate substantial ocular surface damage.
Until recently, around 90 cases of carbide gun–related ocular trauma had been reported in the literature in the last 10 years, describing outcomes ranging from permanent corneal opacity to globe loss depending on the intensity of the blast.[3,4,5,6,7,8] However, none of these studies documented the acute-phase clinical features, and no comprehensive evaluation of the clinicodemographic profile and early treatment outcomes has been performed.
During October 2025, coincident with the festive season in India (Diwali and Chhath festivals), several news reports from different regions of India including Bihar and Madhya Pradesh highlighted a sharp rise in ocular trauma related to carbide guns.[9] Starting around Diwali and within 10 days, 37 cases of carbide gun–related ocular injuries were reported at our center, reflecting a rapidly emerging concern.[10] Given the ongoing surge in cases and the significant threat posed to vision, this situation constituted a public-health emergency requiring urgent documentation and evidence-based preventive recommendation. Therefore, this study was undertaken to describe the clinicodemographic profile and treatment outcomes in ocular trauma resulting from the epidemic of carbide gun injuries that occurred during the year 2025.
Methods
This ambispective observational study included patients with carbide gun–related ocular trauma who presented to the ocular emergency services of a tertiary eye care center in Patna, India, between October 18 and October 28, 2025. Patients who had presented before initiation of the study were included retrospectively from hospital records, while those presenting after initiation were enrolled prospectively. Thus, both retrospective and prospective data collected during the outbreak period were analyzed together. Informed consent was obtained either from the patients themselves or from legal guardians in case of minors. The study conforms to the tenets of the Declaration of Helsinki and good clinical practice guidelines and was expeditiously approved by the Institutional Review Board and Ethics Committee (638/IEC/IGIMS/2025).
Patients of all ages and genders with a history of onset of symptoms immediately following propulsion of a firecracker in front of the affected area, and symptoms and clinical signs consistent with unilateral or bilateral ocular or periocular trauma were included, irrespective of prior treatment status. Patients with history of trauma by any firecracker other than carbide gun were excluded.
All patients underwent detailed baseline ocular examination and documentation under the following parameters: age, sex, laterality, duration of injury, socioeconomic status of the patients, and best corrected visual acuity (BCVA) at presentation; slit lamp examination was performed to assess the cornea, limbus, and conjunctival involvement. Grade of injury was classified according to Dua’s classification, and grading of corneal clarity on the basis of corneal haze was recorded.[11,12] The anterior chamber, iris, and lens were assessed. Dilated fundus examination was performed whenever feasible. B-scan ultrasound was performed over the closed eyelids in cases of opaque media. Anterior segment optical coherence tomography (AS-OCT) was done to measure the corneal thickness (CT), and depth of corneal haze and foreign bodies. Intraocular pressure (IOP) was measured with a noncontact tonometer. Eyelid burns were graded based on the depth of tissue involvement according to the Jackson method.[13] Each patient or guardian (in case of minors) was interviewed to obtain details about the incident, the patient’s activity at the time of trauma, acquisition of the carbide gun, source of information about its use, use of protective eyewear, and whether the device was self-made or commercially purchased.
Management was planned according to severity of injury. All patients received topical prednisolone acetate 1% in tapering doses over days depending on the extent of involvement and clinical response along with topical moxifloxacin, lubricants, cycloplegics, oral vitamin C (1 g/d), and oral doxycycline (100 mg twice a day). Eyes with Dua’s grade I and II ocular surface burns underwent thorough eye wash and removal of foreign bodies as much as possible with or without bandage contact lens (BCL) application. Eyes with grade ≥III burns underwent immediate foreign bodies removal, necrosed conjunctival debridement, and amniotic membrane transplant (AMT) secured with fibrin glue and 10-0 nylon suture along with lateral paramedian temporary tarsorrhaphy. Collagen sheets were applied in all cases of second-degree eyelid burns. Dry collagen sheets, commercially available in 15 × 30 cm size, were used for eyelid burns. Before application, the sheets were rinsed with normal saline. The burnt eyelid surface was cleaned thoroughly to remove debris and crusts, followed by saline irrigation. The collagen sheet was then trimmed according to the wound size and applied directly over the affected area without glue or bandaging. All patients were followed up weekly to monitor epithelial healing, corneal clarity, and visual recovery.
Data were entered in a Microsoft Excel spreadsheet (Microsoft Corporation, USA). Quantitative variables were expressed as descriptive statistics, and qualitative (categorical) variables were described using frequencies and percentages.
Results
A total of 37 eyes (37 patients) presented with acute ocular trauma secondary to carbide gun explosion during the 10 days period in October 2025. All patients were male, with a median age of 15 years (range: 5-50 years). The majority were students (70.3%), while the remainder were working individuals (29.7%). All incidents occurred during festive celebrations of Diwali and Chhath.
Most patients had primary or secondary level education (75.7%) and predominantly belonged to lower-middle socioeconomic strata (59.5%) according to the revised Kuppuswamy socioeconomic scale.[14] The injuries occurred at home in all cases (100%) reflecting the domestic and unsupervised nature of carbide gun usage. None of the patients were using protective eyewear at the time of injury. The timing of injury was almost equally distributed between 12 noon–6 pm (48.6%) and 6 pm–12 midnight (51.4%). Most victims were the operators of the device (67.6%), while the rest were bystanders (32.4%). Regarding the mechanism of injury, 83.8% of cases occurred during checking of the device after ignition failure, 13.5% during or after burst, and 2.7% while mixing carbide with water. The source of information about carbide gun preparation was mainly the Internet (64.9%), followed by peers (29.7%) and local vendors (5.4%). Only 16.2% of the devices were commercially available, while the majority (83.8%) were home-assembled using PVC pipes and CaC2. The estimated cost of each device ranged between ₹60 and ₹200 (USD 0.8 to 2.5). Demographic details and incident-related parameters for all patients are presented in Table 1.
Table 1.
Demographic and incident-related characteristics of patients (n=37) with carbide gun–related ocular trauma
| Variables | Number | Percentage | ||||
|---|---|---|---|---|---|---|
| Median age (IQR, range) | 15 (12, 5-50) years | |||||
| Gender | Male | 37 | 100% | |||
| Female | 00 | |||||
| Occupation | Student | 26 | 70.3% | |||
| Working | 11 | 29.7% | ||||
| Occasion | Festive | 37 | 100% | |||
| Nonfestive | 00 | |||||
| Educational status | No education | 04 | 10.8% | |||
| Primary or below | 14 | 37.8% | ||||
| Secondary | 14 | 37.8% | ||||
| Graduate or above | 05 | 13.5% | ||||
| Socioeconomic status | Lower | 06 | 16.2% | |||
| Lower-middle | 22 | 59.5% | ||||
| Middle | 09 | 24.3% | ||||
| Place of injury | Home | 37 | 100% | |||
| Workplace | 00 | |||||
| Playground | 00 | |||||
| Time of injury | 12 noon–6 pm | 18 | 48.6% | |||
| 6 pm–12 midnight | 19 | 51.3% | ||||
| Role during incident | Operator | 25 | 67.6% | |||
| Bystander | 12 | 32.4% | ||||
| Mode of trauma | During mixing with water | 1 | 2.7% | |||
| During or after burst | 5 | 13.5% | ||||
| While checking a gun which failed to fire | 31 | 83.8% | ||||
| Use of protective eyewear | Yes | 00 | ||||
| No | 37 | 100% | ||||
| Source of information | Internet | 24 | 64.9% | |||
| Peers | 11 | 29.7% | ||||
| Local vendors | 02 | 5.4% | ||||
| Commercial availability | Commercially available | 06 | 16.2% | |||
| Home-assembled | 31 | 83.8% | ||||
Clinical presentation and ocular findings
Of the 37 patients, 89.2% had right-eye involvement and 10.8% had left-eye involvement. None had bilateral injury. The mean presenting BCVA was 2.09 ± 0.79 logMAR units with the majority, 81.1%, presenting worse than 6/60 (logMAR >1.0).
All patients exhibited combined thermal and chemical components of injury with corneal clouding and embedded calcium carbide residues [Fig. 1]. Based on Dua’s classification, nearly one-third of patients (32.4%) had grade V ocular surface burns, followed by grade IV in 24.3%. Only three patients each presented with grade VI and grade I injuries. Corneal clarity grading revealed 21.6% eyes with total corneal opacity, 51.4% with obscured pupillary margins, and 18.9% with visible pupillary margins but unclear iris details, while only 8.1% showed minimal haze with visible iris details. The superior conjunctiva was affected in the majority (81.1%), followed by nasal and temporal conjunctiva, whereas the inferior conjunctiva was least involved [Fig. 2].
Figure 1.
A 17-year-old male presenting within 8 hours of carbide gun–related ocular trauma (a) Diffuse slit-lamp image at presentation showing marked corneal edema, multiple embedded calcium carbide particles, mucoid discharge, and eyelid burn. (b) Fluorescein-stained slit image demonstrating a total corneal epithelial defect. (c) Slit-lamp image after calcium particle removal and amniotic membrane transplantation within 24 hours of injury. (d) At 1-week follow-up, showing improving corneal clarity. (e) At 2-week follow-up. (f) At 4-week follow-up, showing a stable ocular surface with a resolving amniotic membrane. (g) AS-OCT at presentation showing marked corneal edema with embedded calcium particles. (h and i) AS-OCT at 2 and 4 weeks demonstrating reduction in corneal edema with persistence of mid-stromal calcium particles
Figure 2.
Slit-lamp photographs demonstrating early clinical findings at presentation and at 4-week follow-up in four patients presenting within 24 hours of carbide gun–related ocular trauma. (a and b) Predominant superior corneal involvement at presentation with subsequent improvement in corneal clarity but persistence of full-thickness embedded calcium particles at 4 weeks. (c and d) Multiple embedded calcium particles with intervening corneal edema at presentation, showing resolution of edema by 4 weeks. (e and f) Superior corneal burn with associated conjunctival ischemia, showing partial resolution at 4 weeks. (g and h) Total corneal epithelial defect at presentation with complete epithelial healing at 4 weeks and appearance of corneal neovascularization
Calcium particles appeared coarse and penetrated the cornea up to the subepithelial (n = 5), anterior stromal (n = 18), midstromal (n = 9), and deep stromal (n = 6) levels. On the conjunctiva, deposits were more superficial with localized necrosis. Early symblepharon was noted in 10.8%. At presentation, the mean central corneal thickness was 798.5 ± 141.9 µm, indicating significant edema. The mean IOP was 16.8 ± 2.17 mmHg. Common adnexal findings included lid burns in 35 patients, superficial partial-thickness burns in 78.0%, deep partial-thickness burns in 18.9%, and early lagophthalmos was documented in one case (2.7%) with grade VI injury. Table 2 summarizes the clinical presentation patterns and early treatment outcomes for all patients.
Table 2.
Clinical profile and management outcomes of patients (n=37) with carbide gun–related ocular trauma
| Variables | Number | Percentage | ||||
|---|---|---|---|---|---|---|
| Presenting BCVA (logMAR, mean±SD) | 2.09±0.79 | |||||
| Laterality | Right Eye | 33 | 89.2% | |||
| Left Eye | 4 | 10.8% | ||||
| Grade of injury (Dua’s classification) | Grade I | 3 | 8.1% | |||
| Grade II | 4 | 10.8% | ||||
| Grade III | 6 | 16.2% | ||||
| Grade IV | 9 | 24.3% | ||||
| Grade V | 12 | 32.4% | ||||
| Grade VI | 3 | 8.1% | ||||
| Grading of corneal clarity (on the basis of corneal haze) | 0: No corneal haze | 0 | ||||
| 1: Iris details visible | 3 | 8.1% | ||||
| 2: Pupillary margin visible, iris details not visible | 7 | 18.9% | ||||
| 3: Pupillary margin not visible | 19 | 51.4% | ||||
| 4: Cornea totally opaque | 8 | 21.6% | ||||
| Central corneal thickness (µm) | 798.5±141.9 | |||||
| Associated adnexal findings | Presence of symblepharon | 04 | 10.8% | |||
| Lid edema | 36 | 97.3% | ||||
| Lid burn | 35 | 94.6% | ||||
| - Superficial partial thickness burn | 27 | 78.0% | ||||
| - Deep partial thickness burn | 7 | 18.9% | ||||
| - Early lagophthalmos | 1 | 2.7% | ||||
| Intraocular pressure (mmHg) | 16.8±2.17 | |||||
| Prior treatment received | 32 | 86.5% | ||||
| Management | Irrigation | 37 | 100% | |||
| Medical treatment | 37 | 100% | ||||
| Medical treatment alone | 01 | 2.7% | ||||
| Medical treatment with BCL application | 03 | 8.1% | ||||
| Amniotic membrane transplantation | 30 | 81.0% | ||||
| Tenoplasty | 02 | 5.4% | ||||
| Symblepharon release | 03 | 8.1% | ||||
| Collagen sheet application on lids | 35 | 94.5% | ||||
| Temporary tarsorrhaphy | 15 | 40.5% | ||||
BCL: Bandage contact lens
Management and outcomes
Most patients (86.5%) had received some form of treatment prior to presentation (eye wash, topical antibiotics, and/or artificial tears). After clinical evaluation, one patient was managed with medical therapy alone, 8.1% with additional BCL application, and 81.0% with additional AMT within 48 hours for early restoration of epithelial integrity. Other acute interventions included tenoplasty performed in 5.4% patients, symblepharon release in 8.1%, and temporary tarsorrhaphy in 40.5%. Collagen sheet was applied to the eyelids in 94.5% patients.
At 1-week follow-up, all patients showed symptomatic improvement and reduction in corneal haze, limbal edema, and inflammation with significant improvement in BCVA (0.83 ± 0.52 logMAR, Table 3). CT decreased to a mean of 537.5 ± 39.7 µm, although calcium particles persisted in most cases. One patient who developed scleral ischemia involving three clock hours required deferred tenoplasty. At 2 weeks, further improvement was noted (mean BCVA: 0.80 ± 0.44 logMAR; mean CT: 529.4 ± 59.4 µm) [Fig. 1]. By 4 weeks, BCVA, corneal clarity, and CT remained stable, but new vessels appeared at the limbus, suggestive of limbal stem cell deficiency (LSCD) in patients with grade IV or higher burns. Most eyelid burns healed well following collagen sheet application. The collagen sheets gradually integrated with the wound surface during healing, while the residual sheet separated spontaneously over approximately 2 weeks without the need for repeat dressing. However, three patients required eyelid surgery: ectropion correction secondary to early lagophthalmos, mucous membrane grafting (MMG) due to scarring of the upper palpebral conjunctiva, and anterior lamellar recession for entropion resulting from extensive upper tarsal conjunctival scarring (one each).
Table 3.
Visual outcomes of 37 patients suffering from calcium carbide–related ocular burn injury
| Best corrected visual acuity | Number of eyes (percent) |
|||
|---|---|---|---|---|
| At presentation | At 4 weeks follow-up | |||
| 20/60 to 20/20 | 03 (8.11%) | 05 (13.51%) | ||
| 20/200 to <20/60 | 04 (10.81%) | 13 (35.14%) | ||
| CF to <20/200 | 17 (45.95%) | 14 (37.84%) | ||
| PL positive to HM | 11 (29.73%) | 04 (10.81%) | ||
| PL denied | 01 (2.70%) | 0 (0.00) | ||
Discussion
This study demonstrates a characteristic pattern of severe unilateral thermochemical ocular burns in young males resulting from the use of self-made carbide guns during festivals. The predominance of right-eye involvement, the domestic setting of injury, and the internet-driven spread of unsafe practices underscore the urgent need for public health awareness and regulatory control over these hazardous devices.
CaC2 is widely used in agricultural settings to promote artificial ripening of fruits, especially mangoes.[3] Carbide guns were originally designed for agricultural use to produce loud explosions and scare away stray animals.[15] When the explosion is misdirected toward the face, the main propellant CaC2 produces thermochemical injury through a combination of high-pressure shock waves, intense heat, and chemical burns from acetylene gas and carbide residues, resulting in extensive ocular surface and adnexal damage. Similar to other alkali burns, these injuries can progress to LSCD with conjunctivalization, further exacerbated by shockwave impact and plastic-debris trauma.
The reported incidence of acute ocular burns in developing countries ranges between 1.25% and 4.4%, most often caused by thermal and chemical injuries.[16] In India, lime (chuna) remains the most common cause of chemical ocular burns in children[17]; however, carbide-related ocular trauma has recently emerged as a significant cause of preventable blindness, especially among children and adolescents. In our study, only two patients were older than 40 years, both being bystanders. All incidents occurred at home, and interviews revealed that brief social media video clips (“reels”) played a major role in popularizing and demonstrating the preparation of these cheap explosive devices. The major risk factors identified were improper handling, low cost, easy availability, and lack of safety awareness.
Consistent with previous studies, right-eye involvement was more frequent likely due to right-hand dominance.[18,19] Most injuries occurred while inspecting the device after ignition failure, when the delayed blast released acetylene gas, carbide particles, and flame, causing severe thermochemical ocular burns. The present study as well as that by Arora et al.[4] reported only unilateral involvement and closed-globe injuries without rupture. In contrast, a study by Bandyopadhyay et al.[3] documented bilateral involvement in 66% of cases and globe rupture in 18%. This difference in injury pattern was attributed to explosions from glass bottles with lids, rather than PVC-based guns. Thus, as with other causes of ocular trauma, the novelty of the design of the carbide gun played a significant role in determining the severity and pattern of injury.
To date, only five studies have described carbide gun–related ocular trauma [Table 4].[3,4,5,6,7] Since our study included all cases presenting within 10 days, we could comprehensively describe the early clinical findings. The majority (64.8%) had severe ocular surface damage with grade IV–VI burns, whereas previous study reported 42.8% cases with severe grade IV and above.[4] All patients showed superior conjunctival involvement likely due to upward gaze during device inspection. High-velocity calcium particles were embedded within the cornea extending from the subepithelial to the deep stromal layers, causing marked corneal edema. In contrast, conjunctival deposits were superficial, and fornices spared, possibly due to the eye’s positioning while inspecting the device. Consequently, complete corneal particle removal was not possible, while less conjunctival debridement was required.
Table 4.
Literature review on carbide gun–related ocular trauma
| Authors | Present study | Bandyopadhyay M et al. (2013)[3] | Arora et al. (2023)[8] | Kabra N et al. (2020)[5] | Sabde Y et al. (2023)[6] | Sanjay S et al. (2022)[7] | ||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Number of eyes (patients) | 37 (37) | 55 (33) | 15 (14) | 14 (13) | 5 (5) | 1 (1) | ||||||
| Study design | Ambispective | Prospective | Retrospective | Prospective | Case series | Case report | ||||||
| Duration of study | 10 days | One year | One year | one month | Not mentioned | Not applicable | ||||||
| Age range (years) | 5 to 50 | 9 to 50 | 23.57±11.76 | Young | 16.2±4.3 | 44 | ||||||
| Gender distribution | All male | M:F 20:13 | All male | All male | All male | Male | ||||||
| Time of injury | During festivals | Mango ripening season | Not mentioned | Agricultural work | Not mentioned | Agricultural worker | ||||||
| Social media influence | Yes | Yes | Not mentioned | Yes | Yes | Not mentioned | ||||||
| Region of Incident | Bihar, Eastern India | West Bengal, eastern India | Not mentioned | West India | Central India | South India | ||||||
| Type of firecracker/device causing injury | Calcium carbide gun | Calcium carbide ignition | Calcium carbide guns | Calcium carbide gun | Calcium carbide gun | Air gun loaded with carbide | ||||||
| Mechanism of injury | Mishandling leading to direct impact or chemical exposure | Explosion/chemical exposure | Not explicitly mentioned | Mishandling leading to direct impact or chemical exposure | Mishandling leading to direct impact or chemical exposure | Likely direct impact or chemical exposure | ||||||
| Anatomical location of injury | Closed globe injury with ocular surface damage | Closed and open globe injury with ocular surface damage | Closed globe injury with ocular surface damage | Not mentioned | Closed globe injury with ocular surface damage | Closed globe injury with ocular surface damage and hyphema | ||||||
| Visual acuity at presentation | No PL to 20/20 | No PL to 20/40 | HM to 20/50 | PL to 20/60 | HM to 20/40 | 20/250 | ||||||
| Severity classification used | Dua’s classification | BETTS | Dua’s classification | Dua’s classification | Not mentioned | Not mentioned | ||||||
| Specific injury grade | Grade I-II (7 eyes), Grade III (6 eyes), Grade IV-VI (24 eyes) | 10 open globe injuries, 45 closed globe injuries | Grade I-II (5 eyes), Grade III (3 eyes), Grade IV-VI (7 eyes) | Grade I-II (4 eyes), Grade III (3 eyes), Grade IV-VI (7 eyes) | Not mentioned | Not mentioned | ||||||
| Surgical procedures performed | AMT for grade III-VI injuries, tenoplasty, tarsorrhaphy | Repair of sclero-corneal ruptures, enucleation in one case. | AMT for grade III-V injuries | AMT I in 3 cases, tenoplasty in one case | AMT I in 2 cases | None | ||||||
| Clinical findings at follow-up | Vision improved in all patients except 4 patients. | Vision improved in all patients except three. | Complete epithelization in 10 eyes (66.6%) | Not mentioned | Corneal opacity persisted, vision improved | Visual acuity improved to 20/20 | ||||||
| Long-term complications | Yet to be determined | Permanent vision impairment in some patients. | Partial limbal stem cell deficiency and conjunctivalization | Not mentioned | Not mentioned | Not mentioned. | ||||||
| Recommendations for prevention | Awareness and regulation | Safer ripening agents | Advocacy for prevention | Surveillance and control | Safe handling practices | Education on risks and eye protection |
Although the follow-up period was limited, all patients demonstrated symptomatic relief, better corneal clarity, and improved visual acuity at 1 week which then stabilized by 4 weeks. Along with medical therapy, all grade III–VI cases underwent AMT resulting in significant improvement in BCVA and reduction in corneal thickness. As an adjunct, AMT reduced inflammation, promoted epithelial regeneration, and minimized scarring and neovascularization. However, the efficacy of AMT after ocular surface burns depends on the survival of a sufficient pool of functioning limbal stem cells. It is known that AMT can expedite healing in moderate ocular surface burns but may not reliably enhance re-epithelialization in severe burns.[20] In a retrospective study of carbide-related ocular burns, Arora et al.[4] reported LSCD in 75% of eyes with Dua’s grade IV–VI injuries compared with only 12.5% of eyes with grade I–III injuries, highlighting the strong association between burn severity and long-term ocular surface failure. Consistent with this, burns of grade IV or worse severity showed progressive corneal neovascularization in the present study. Ocular Trauma Score (OTS) was not applied in this study because the lesions predominantly involved the ocular surface;[21] therefore, management and prognostic assessment were based on Dua’s classification of ocular surface burns.[11]
Fire cracker injuries mostly tend to have either only epidermal or dermal involvement and are categorized in first- or second-degree burns. Superficial injuries tend to heal spontaneously within a week’s time, but some cases may show early cicatricial ectropion if not addressed promptly.[22] In this series, eyelid burns demonstrated progressive healing following treatment with collagen sheets (single-layer or multilayered). Although collagen sheets are widely used for burn dressings elsewhere on the body, there is limited literature on their use in eyelid thermal burns. It serves as a biomechanical regenerative matrix facilitating angiogenesis with proliferation of fibroblasts and neo-dermal collagen synthesis. The property of modulating fluid efflux from wound and acting as a barrier from microbes are its additional properties serving in the purpose of wound healing.[23,24] In the present study, all affected patients had excellent outcomes, with only three requiring additional corrective procedures.
The unsupervised use of carbide guns and the absence of protective eyewear in all patients reflect poor public awareness regarding their potential danger. Although these devices are often treated as recreational toys, they can cause severe vision-threatening ocular burns. This study therefore underscores the urgent need for parental supervision, community education, and public awareness campaigns focused on ocular safety during festivals.[25] Social media platforms should restrict content promoting unsafe experiments, while policy-level measures are needed to control the availability and misuse of calcium carbide. Stricter regulation and improved health-care surveillance are essential to prevent this avoidable cause of blindness.
This study has several strengths including documentation of a short-term outbreak, detailed recording of very early clinical findings, AS-OCT assessment of the depth of calcium particle penetration, and evaluation of early healing patterns following prompt intervention. However, it also has limitations including its single-center design, short follow-up period of 4 weeks, and prior treatment received by some patients before presentation. Longer follow-up is required to assess final visual outcomes and the development of LSCD.
Conclusion
Carbide gun–related ocular trauma causes severe, vision- threatening thermochemical ocular injuries predominantly in children and adolescents. Early AMT improves short-term outcomes, but severe grade burns carry a high risk of LSCD. Public awareness, regulation of calcium carbide availability, and social-media control are needed to prevent this avoidable blindness.
Ethics approval
This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Institute Ethics Committee of Indira Gandhi Institute of Medical Sciences, Patna (Bihar) India [638/IEC/IGIMS/2025]
Consent to participate
Written informed consent was obtained from the all patients and from parents in case of minors.
Conflicts of interest
There are no conflicts of interest.
Acknowledgement
The authors acknowledge Dr Ankita Singh, Dr Vandana Parasar, and Dr Pallavi Dokania for their assistance in patient documentation during the study period.
Funding Statement
Nil.
References
- 1.Anchouche S, Hall N, Bal S, Dana R, Elze T, Miller JW, et al. Chemical and thermal ocular burns in the United States: An IRIS registry analysis. Ocul Surf. 2021;21:345–7. doi: 10.1016/j.jtos.2021.03.008. [DOI] [PubMed] [Google Scholar]
- 2.Wisse RP, Bijlsma WR, Stilma JS. Ocular firework trauma: A systematic review on incidence, severity, outcome and prevention. Br J Ophthalmol. 2010;94:1586–91. doi: 10.1136/bjo.2009.168419. [DOI] [PubMed] [Google Scholar]
- 3.Bandyopadhyay S, Saha M, Biswas S, Ranjan A, Naskar AK, Bandyopadhyay L. Calcium carbide related ocular burn injuries during mango ripening season of West Bengal, eastern India. Nepal J Ophthalmol. 2013;5:242–5. doi: 10.3126/nepjoph.v5i2.8736. [DOI] [PubMed] [Google Scholar]
- 4.Arora A, Shanbhag SS, Mishra DK, Malepati N, Das S, Priyadarshini SR, et al. Sequelae of carbide-related thermo-chemical injury: A retrospective analysis. Indian J Ophthalmol. 2023;71:3192–7. doi: 10.4103/IJO.IJO_57_23. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Kabra N, Gupta S. Role of social media as a catalyser for ocular injury: A case study of calcuim carbide gun use in India. Delhi J Ophthalmol. 2020;31:62–4. [Google Scholar]
- 6.Sabde YD, Trushna T, Bhartiya P, Tiwari RR. Vision-threatening ocular injury secondary to calcium carbide gun use in Indian children and young adults: A case series. Indian J Ophthalmol Case Rep. 2023;3:840–3. [Google Scholar]
- 7.Sanjay S, Gupta A, Uday S. Scare air gun-induced ocular trauma in an agriculture farm in India. Pan Am J Ophthalmol. 2022;4:56. [Google Scholar]
- 8.Arora A, Priyadarshini SR, Das S, Mohanty A, Shanbhag SS, Sahu SK. Carbide gun-related ocular injuries: A case series. Cornea. 2023;42:726–30. doi: 10.1097/ICO.0000000000003095. [DOI] [PubMed] [Google Scholar]
- 9.Jaiswal A. Gun that kills fun: Injuries linked to carbide crackers trigger scare. The Times of India. 2025. Available from: https://timesofindia.indiatimes.com/city/delhi/gun-that-kills-fun-injuries-linked-to-carbide-crackers-trigger-scare/articleshow/124912348.cms. [Last accessed on 2025 Oct 30]
- 10.Mollan C. Carbide guns: How a DIY cracker in India went from social media craze to blinding children. BBC News. 2025. Available from: https://www.bbc.com/news/articles/c3w9d7270x2o. [Last accessed on 2025 Oct 28]
- 11.Dua HS, King AJ, Joseph A. A new classification of ocular surface burns. Br J Ophthalmol. 2001;85:1379–83. doi: 10.1136/bjo.85.11.1379. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.Gupta N, Kalaivani M, Tandon R. Comparison of prognostic value of Roper Hall and Dua classification systems in acute ocular burns. Br J Ophthalmol. 2011;95:194–8. doi: 10.1136/bjo.2009.173724. [DOI] [PubMed] [Google Scholar]
- 13.Malhotra R, Sheikh I, Dheansa B. The management of eyelid burns. Surv Ophthalmol. 2009;54:356–71. doi: 10.1016/j.survophthal.2009.02.009. [DOI] [PubMed] [Google Scholar]
- 14.Majumder S. Socioeconomic status scales: Revised Kuppuswamy, BG Prasad, and Udai Pareekh’s scale updated for 2021. J Family Med Prim Care. 2021;10:3964–7. doi: 10.4103/jfmpc.jfmpc_600_21. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Innovative scare gun a hit among farmers. The Times of India. 2018. Available from: https://timesofindia.indiatimes.com/city/kozhikode/innovative-scare-gun-a-hit-among-farmers/articleshow/62781723.cms. [Last accessed on 2018 Feb 05]
- 16.Xie Y, Tan Y, Tang S. Epidemiology of 377 patients with chemical burns in Guangdong province. Burns. 2004;30:569–72. doi: 10.1016/j.burns.2004.01.028. [DOI] [PubMed] [Google Scholar]
- 17.Kate A, Sharma S, Yathish S, Das AV, Malepati N, Donthineni PR, et al. Demographic profile and clinical characteristics of patients presenting with acute ocular burns. Indian J Ophthalmol. 2023;71:2694–703. doi: 10.4103/IJO.IJO_3330_22. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18.Carey DP. Vision research: Losing sight of eye dominance. Curr Biol. 2001;11:R828–30. doi: 10.1016/s0960-9822(01)00496-1. [DOI] [PubMed] [Google Scholar]
- 19.Coren S, Porac C. Fifty centuries of right-handedness: The historical record. Science. 1977;198:631–2. doi: 10.1126/science.335510. [DOI] [PubMed] [Google Scholar]
- 20.Veldman PB, Greiner MA, Cortina MS, Kuo AN, Li JY, Miller DD, et al. Efficacy of amniotic membrane grafting for the treatment of chemical and thermal ocular surface injuries: A report by the American Academy of Ophthalmology. Ophthalmology. 2025;132:154–63. doi: 10.1016/j.ophtha.2024.08.021. [DOI] [PubMed] [Google Scholar]
- 21.Kuhn F, Maisiak R, Mann L, Mester V, Morris R, Witherspoon CD. The ocular trauma score (OTS) Ophthalmol Clin North Am. 2002;15:163–5. doi: 10.1016/s0896-1549(02)00007-x. [DOI] [PubMed] [Google Scholar]
- 22.Keilani C, De Faria A, Baus A, Delbarre M, Schaal JV, Froussart-Maille F, et al. Eyelid chemical burns: A multidisciplinary and challenging approach. Ann Burns Fire Disasters. 2021;34:312–8. [PMC free article] [PubMed] [Google Scholar]
- 23.Lazovic G, Colic M, Grubor M, Jovanovic M. The application of collagen sheet in open wound healing. Ann Burns Fire Disasters. 2005;18:151–6. [PMC free article] [PubMed] [Google Scholar]
- 24.Sklenářová R, Akla N, Latorre MJ, Ulrichová J, Franková J. Collagen as a biomaterial for skin and corneal wound healing. J Funct Biomater. 2022;13:249. doi: 10.3390/jfb13040249. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 25.Sinha S, Nishant P, Morya AK, Bejjenki P. Commentary: The untapped potential of protective eyewear for primary prevention of ocular trauma. Indian J Ophthalmol. 2023;71:2215–6. doi: 10.4103/IJO.IJO_3376_22. [DOI] [PMC free article] [PubMed] [Google Scholar]