AUTHOR COMMUNICATION  
Party Poppers and Balloons: Fun and  
Games or Lives and Limbs?  
Fiza Shaheen1, Rehan Naqaish2, Amer Awan3  
1-3Department of Ophthalmology, Shifa International Hospital, Shifa College of Medicine (STMU), Islamabad  
ABSTRACT  
We report two cases of ocular trauma caused by recently popular party poppers and LED balloons, commonly  
used in parties nowadays. One case depicted a closed globe injury as a result of a party popper spray over the  
eye. The pressure of the spray resulted in a blunt trauma causing full thickness macular hole which was later  
treated with Pars Plana Vitrectomy (PPV) surgery. The second case is an example of an open globe injury  
caused by the bursting of LED balloon over the eye of a young child resulting in corneal perforation, traumatic  
cataract, vitreous hemorrhage with an intraocular foreign body (IOFB). It was successfully treated with corneal  
suturing, lens extraction, PPV surgery and removal of IOFB followed by a secondary lens implantation. Both of  
the sustained injuries were completely avoidable hence emphasizing the requirement of eye safety awareness  
programs and diligence in the use of these gadgets in everyday lives.  
Key Words: Ocular trauma, Macular hole, Intra ocular foreign body, Pars Plana Vitrectomy.  
How to Cite this Article: Shaheen F, Naqaish R, Awan A. Party Poppers and Balloons: Fun and Games or  
Lives and Limbs? Pak J Ophthalmol. 2020; 36 (1): 177-179.  
Doi: 10.36351/pjo.v36i1.975  
INTRODUCTION  
CASE 1:  
Ocular injury is one the leading causes of visual  
impairment worldwide causing blindness in  
approximately 1.6 million people with children being  
at a greater risk due to their inability to characterize  
the nature of objects1. Most of these injuries being  
preventable by the utilization of various simple  
measures make this a matter of concern2-5.  
A 20 years old lady presented in our outpatient  
department with one-week history of sudden loss of  
vision in her left eye after direct injury with the spray  
of a party popper. Her visual acuity was counting  
fingers close to face with sluggishly reacting left pupil.  
Her anterior segment was normal but her fundus  
examination revealed a full thickness macular hole.  
Optical coherence tomography confirmed it and the  
width of hole was 1192 microns at base and 492  
microns at apex.  
With the advancements in the fields of engineering  
and technology and incorporation of various gadgets in  
our daily lives without their implications is a serious  
concern. One of such example is commonly used party  
accessories and decorations including Party poppers,  
foam sprays, helium balloons, LED (light emitting  
diode) lights and LED balloons.  
She underwent 27 gauge 3 ports Pars Plana  
Vitrectomy (3PPV), inner limiting membrane (ILM)  
peel and 18% C2F6 gas tamponade. Posterior vitreous  
detachment was induced and complete vitrectomy was  
performed. ILM was peeled with adjunct use of ILM  
blue dye. Fluid air exchange was carried out in the end  
which was followed by 18% C2F6 gas injection.  
Wounds were secured and sub conjunctival  
gentamycin and dexamethasone were injected. Post  
operatively she was started on topical antibiotics and  
We report two cases of trauma with party  
accessories resulting in serious ocular injuries.  
Correspondence to: Dr. Fiza Shaheen,  
Post Graduate Trainee, Shifa International Hospital,  
Islamabad.  
Email: fiza_shaheen@hotmail.com  
177  
Pakistan Journal of J Ophthalmology, 2020, Vol. 36 (1): 177-179  
Party Poppers and Balloons: Fun and Games or Lives and Limbs?  
steroid for a period of 4 weeks. One week  
postoperatively, her visual acuity was hand movement  
with 65% gas in the vitreous cavity. Her OCT Scan  
showed closure of macular hole (Figure 1B). After one  
month post-operatively her visual acuity had improved  
to 0.9 logarithm of minimum angle of resolution (log-  
MAR). At two months post operatively it further  
improved to 0.3 log-MAR.  
carried out which showed a hyper reflective IOFB in  
the vitreous cavity with dense vitreous hemorrhage  
(Figure 2A).  
She underwent right cataract extraction and 27G  
3-port PPV under GA. After cataract extraction, two  
27G scleral ports were made and infusion was inserted  
in anterior chamber. Dense vitreous hemorrhage was  
cleared and a large metallic foreign body of  
approximately 7 mm in length was found lying over  
the macula (Figure-2C). It was lifted with micro  
forceps and removed through corneal incision.  
Peripheral vitrectomy was completed and retinal  
periphery was searched via scleral indentation. Laser  
was done nasal to the macula at the suspected site of  
impact. Corneal wounds were closed with 10 – 0 nylon  
and sclerotomies with 6 – 0 Vicryl followed by sub  
conjunctival  
gentamycin  
and  
dexamethasone  
injections. Post operatively, the patient was given  
topical steroids and antibiotics for a month.  
Foreign body that was removed was later  
confirmed to be present inside the LED balloon. It was  
a hook attached with the encased battery and bulb used  
inside the balloon (Figure 2B).  
At 3 months her visual acuity was 0.9 log-MAR  
Fig. 1: Above: Post traumatic Full thickness macular hole. Below:  
Post Vitrectomy closure of macular hole.  
CASE 2:  
Fig. 2: (Left): B scan showing a hyper reflective IOFB with dense  
vitreous hemorrhage. (Right): Large metallic foreign body  
removed from the vitreous cavity.  
A 4 years old young girl presented to emergency  
department with the history of trauma due to the  
bursting of a LED balloon in front of her right eye few  
hours prior to presentation and complained of severe  
pain, watering and redness. Visual acuity could not be  
assessed as the child was very irritable. On  
examination there was a central and superior full  
thickness corneal laceration with iris prolapse along  
with the suspicion of a superior lenticular opacity. Her  
cornea was sutured with 10-0 nylon immediately under  
general anesthesia (GA). Necrotic superior iris strands  
were excised. Lens was opaque and there was a  
superior capsular tear as well. It was decided to leave  
the cataract and remove it later.  
She was referred to our vitreoretinal team for  
further management. Her B Scan ultrasonography was  
Fig. 3: LED balloon uses an encased battery attached with an LED  
bulb via hook.  
Pakistan Journal of J Ophthalmology, 2020, Vol. 36 (1): 177-179  
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Fiza Shaheen, et al  
with +13.00 Diopter spherical lens. After two and half  
months, secondary lens implant in the sulcus was  
performed after which her visual acuity improved to  
0.5 log-MAR with best correction. Later she was  
advised patching to prevent amblyopia and vision  
further improved to 0.3 log-MAR.  
Author’s Contribution  
FS: Manuscript drafting, literature review and final  
review.  
RN: literature search and final review.  
AA: literature search and final review.  
Conflict of Interest  
Authors declared no conflict of interest.  
DISCUSSION  
Ocular trauma is quiet common especially in the  
developing countries accounting for 12.9% of all the  
admitted cases6. The common causes include injury  
with bow and arrows, needles, tools and hooks and  
firecracker injury. According to the Ocular Trauma  
Classification group, nature of injuries can be  
classified as closed globe injuries and open globe  
injuries as well as a third group of chemical injuries7.  
REFERENCES  
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Ocular trauma with party accessories was reported  
in another study in which chemical injuries caused by  
snow sprays including chemical conjunctivitis,  
superficial punctate keratopathy, corneal and  
conjunctival erosions8. Other studies described the  
ocular injuries caused by water balloon slingshots9.  
Pellet gun injuries have been mentioned in local  
literature11.  
5. Nelson LB, Wilson TW, Jeffers JB. Eye injuries in  
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Ocular and orbital trauma from water balloon  
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The two cases we have described above highlight  
the potential of these gadgets in causing open as well  
as closed globe injuries. Although the introduction of  
various hi tech gadgets in our everyday life style have  
improved the quality of life in various ways, their use  
must be accompanied with safety measures. There  
should be proper guidelines regarding their utility and  
the description of their potential harm must be  
discussed. With the common utilization of these  
devices, such devastating incidents might increase in  
the future which should be effectively tackled before  
time.  
10. Cohn RA, Olsen KR. Retinal commotio and tears from  
a water balloon injury. Arch Ophthalmol. 1994; 112  
(8): 1021–1021.  
11. Bahoo MLA, Jamil AZ, Karamat B. Frequency and  
characteristics of ocular trauma in a Tertiary Care  
Hospital in Lodhran. Pak J Ophthalmol. 2019; 35 (2):  
116-12.  
CONCLUSION  
We strongly stress the need of awareness programs  
using social and media services. Party accessories  
although intended for fun, must be carefully used if  
not possibly avoided.  
.…….  
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