Coughing can sometimes lead to a sharp, though usually brief, sensation of pain in or around the eyes. This phenomenon is a recognized experience and is generally a result of the rapid physiological changes that occur in the head and chest during a forceful expulsion of air. While the pain is often harmless and temporary, it is a direct consequence of the physical mechanics of coughing.
How Increased Pressure Affects Eye Structures
A forceful cough triggers a physiological event known as the Valsalva maneuver, which involves a sudden, strong contraction of the chest and abdominal muscles against a partially closed airway. This action causes a rapid and significant spike in pressure within the chest cavity, known as the intrathoracic pressure. This pressure surge is then transmitted upward into the head and face.
The veins in the head and neck, which drain blood from the eyes and brain, lack valves, allowing this sudden pressure to be easily transmitted. This leads to a momentary congestion of blood vessels and an increase in episcleral venous pressure. The rise in pressure causes the intraocular pressure (IOP), the fluid pressure inside the eyeball, to increase temporarily. This transient pressure change places stress on sensitive eye structures, such as the optic nerve sheath, resulting in the fleeting pain sensation. The mechanical stress can also cause transient visual disturbances, often described as seeing bright spots or lights (photopsia). In rare cases of violent coughing, this pressure may cause a subconjunctival hemorrhage, a visible but generally harmless burst blood vessel on the eye’s surface.
Referred Pain from Sinuses and Muscles
Eye pain experienced during a cough is not always a direct result of pressure changes within the eyeball; it can also be a form of referred pain originating from surrounding anatomical structures. The sinuses are hollow, air-filled cavities located near and behind the eyes, and are intimately connected to the respiratory system. When a person has an infection, such as sinusitis, these cavities become inflamed and congested with mucus.
The forceful vibration and strain from coughing can jar these inflamed sinus walls, intensifying the pressure and pain that radiates into the orbital region. This pain is often felt as a dull ache or a sensation of fullness behind the eyes, particularly if the frontal, ethmoid, or sphenoid sinuses are affected. Furthermore, the repetitive action of a persistent cough can cause significant strain on the muscles of the head, neck, and face. Muscle tension and spasms in the neck and jaw can be perceived as pain that originates in the eye socket, which is a secondary effect of the physical exertion of coughing.
Serious Symptoms Requiring Medical Evaluation
While most instances of cough-induced eye pain are benign and resolve quickly, certain accompanying symptoms should prompt an immediate medical evaluation. The most concerning sign is eye pain that persists long after the coughing fit has ended, suggesting a more sustained underlying problem. Changes in vision, such as blurriness, double vision, or a sudden loss of sight, are also red flags that require urgent attention.
A sudden, severe headache that peaks immediately with the cough, known as a cough headache, could indicate an underlying neurological issue that needs investigation. Eye pain accompanied by severe nausea, vomiting, or the appearance of halos around lights may signal an acute change in intraocular pressure, possibly related to conditions like acute angle-closure glaucoma. Individuals with pre-existing eye conditions, such as retinopathy or a history of retinal detachment, should seek medical advice if they experience eye pain after coughing, as they are at a higher risk for complications.