The increasing ptosis may lead to the eyelid covering the pupil and impairing vision. In an effort to compensate for this the forehead muscle becomes overactive, trying to help to lift up the eyelids, giving a frowning appearance, and the patient adopts a rather characteristic posture with the head tilted backwards. Dysphagia, which initially applies mainly to solid and dry foods, progresses slowly and eventually even swallowing fluids, including saliva, may become a problem. If dysphagia is severe, then there is a danger of aspiration, i.e. food and saliva overflowing into the wind-pipe leading to chest infection. After many years the patient may become aware of mild limb weakness, first around the shoulders and later around the hips, and of facial weakness, but marked weakness is uncommon.
Life expectancy is little, if at all, altered.
There is no specific treatment for OPMD, but much that can be done to help the main symptoms of ptosis and dysphagia. If these are unacceptable, and if the ptosis is severe, surgical elevation of the eyelids can be very successful. In more severe cases, a relatively minor operation called cricopharyngeal myotomy, which cuts one of the throat muscles internally, can be valuable. If the dysphagia is preventing adequate nutrition or there is a risk of aspiration pneumonia, then alternative methods of feeding can be used. The most acceptable, in the long term, is gastrostomy.