Shih Tzu Health Guide: What Every Owner Needs to Know

Breed Overview

The Shih Tzu (meaning "lion dog") has roots stretching back over 1,000 years in Chinese and Tibetan royal courts. Standing just 9-10.5 inches at the shoulder and weighing 9-16 pounds, they are sturdy little dogs with a surprisingly solid build beneath their flowing coat. Shih Tzus come in virtually every color and color combination, and their long, luxurious double coat is one of the breed's most distinctive features.

Temperament-wise, Shih Tzus are friendly, outgoing, and trusting. They were bred specifically to be companions, and they excel at it. They are generally good with children, other dogs, and even strangers. While they can be stubborn about training, they are affectionate and playful. Unlike many toy breeds, Shih Tzus tend to be confident and less prone to excessive barking, though individual temperaments vary.

Top Health Concerns for Shih Tzus

1. Brachycephalic Airway Syndrome

Brachycephalic airway syndrome (BAS) is the most significant health issue facing Shih Tzus. Their characteristic flat face is the result of a shortened skull, but the soft tissues of the airway have not proportionally reduced. This creates a constellation of anatomical problems: stenotic nares (narrowed nostrils), elongated soft palate, hypoplastic trachea (narrower-than-normal windpipe), and everted laryngeal saccules. The combined effect is chronic airway obstruction of varying severity.

Affected Shih Tzus exhibit noisy breathing, snoring (even while awake), snorting, gagging, exercise intolerance, and in severe cases, cyanosis (blue-tinged gums from oxygen deprivation) and collapse. Symptoms worsen dramatically in heat and humidity, during excitement, and with even modest excess weight. The condition is progressive: the increased effort required to breathe through a compromised airway causes secondary changes such as laryngeal collapse, which further narrows the airway over time.

Mild cases are managed with weight control, avoiding heat and humidity, using a harness instead of a collar, and limiting intense exercise. Moderate to severe cases benefit from surgical correction, ideally performed early before secondary changes develop. Surgery may include widening the nostrils (rhinoplasty), shortening the soft palate (staphylectomy), and removing everted laryngeal saccules. These procedures significantly improve breathing and quality of life. All Shih Tzus should be kept in air-conditioned environments during warm weather, and owners must recognize that heat stroke is a genuine and potentially fatal risk.

2. Eye Problems — Proptosis, Dry Eye, and Progressive Retinal Atrophy

Shih Tzus are among the most eye-vulnerable breeds in existence. Their shallow eye sockets and prominent, globe-shaped eyes create multiple risks. Proptosis (displacement of the eyeball from the socket) is a genuine emergency that can occur from surprisingly minor trauma, rough play, or even restraint around the neck. If the eye pops forward, it constitutes an immediate veterinary emergency. Keep the eye moist with saline, prevent the dog from pawing at it, and get to a veterinarian within minutes. The prognosis depends entirely on the speed of treatment — delayed replacement can result in permanent blindness or loss of the eye.

Keratoconjunctivitis sicca (KCS, or dry eye) is extremely common in Shih Tzus, affecting an estimated 15-20% of the breed. KCS occurs when the tear glands produce insufficient aqueous tears, leading to chronic corneal dryness, inflammation, mucoid discharge, corneal ulceration, and eventual corneal scarring that can cause blindness. Daily treatment with cyclosporine or tacrolimus eye drops stimulates tear production and is typically lifelong. Artificial tear supplements are used for additional comfort.

Progressive Retinal Atrophy (PRA) also affects the breed, causing gradual degeneration of the retina and eventual blindness. Early signs include night blindness and dilated pupils. There is no treatment for PRA, but affected dogs adapt remarkably well to vision loss in familiar environments. Corneal ulcers are another frequent problem due to the eyes' prominence and exposure. Any squinting, tearing, cloudiness, or redness should prompt an immediate veterinary visit, as ulcers can perforate rapidly.

3. Patellar Luxation — Prevalence: ~15-20%

Patellar luxation (slipping kneecap) is one of the most common orthopedic conditions in small breeds, and Shih Tzus are among the most frequently affected. The condition involves the kneecap (patella) dislocating from its normal groove in the femur, typically sliding medially (toward the inside of the leg). Luxation is graded on a scale of 1-4, from intermittent manual luxation that spontaneously reduces (Grade 1) to permanent luxation that cannot be manually replaced (Grade 4).

Signs include intermittent skipping or hopping on one hind leg, a "bow-legged" appearance, and reluctance to jump. Many dogs learn to kick the leg out to pop the kneecap back into place, resuming normal gait. While Grade 1-2 luxation may be managed conservatively with weight management and joint supplements, Grade 3-4 typically requires surgical correction to prevent progressive cartilage damage and arthritis. Untreated patellar luxation can lead to cranial cruciate ligament rupture due to abnormal mechanical forces on the knee.

4. Dental Disease — Prevalence: Nearly Universal

Dental disease is arguably the most pervasive health problem in Shih Tzus. Their small jaws result in crowded, misaligned teeth that create traps for food and bacteria. The brachycephalic jaw structure means there is simply not enough room for a full set of teeth, leading to overlapping, rotated, and retained deciduous (baby) teeth. This overcrowding accelerates plaque and tartar accumulation, gingivitis, periodontal disease, and tooth loss.

Studies show that by age 3, the vast majority of Shih Tzus have some degree of periodontal disease. Advanced periodontal disease doesn't just cause bad breath and tooth loss — the bacteria can enter the bloodstream and damage the heart, liver, and kidneys. Prevention requires daily tooth brushing (the single most effective measure), dental chews, and professional dental cleanings under anesthesia as recommended by your veterinarian. Note that anesthesia in brachycephalic breeds requires extra precautions due to their compromised airways, so choose a veterinarian experienced with flat-faced breeds.

5. Ear Infections — Recurring Issue

Shih Tzus' floppy, heavily furred ears create a warm, moist environment ideal for bacterial and yeast overgrowth. Hair grows inside the ear canal, further trapping moisture and debris. Chronic otitis (ear inflammation and infection) is one of the most frequent reasons Shih Tzu owners visit the veterinarian.

Signs include head shaking, ear scratching, redness, odor, and dark or yellowish discharge. Prevention involves regular ear cleaning (weekly for most Shih Tzus), keeping the ear canal hair trimmed or plucked by a groomer, and thoroughly drying ears after baths or swimming. Recurring infections may indicate underlying allergies (food or environmental), which should be investigated if infections persist despite good ear hygiene.

Recommended Health Screenings

The American Shih Tzu Club recommends these health evaluations:

• Ophthalmologist evaluation — Annual OFA eye exam, critical given the breed's extreme eye vulnerability
• Patellar evaluation — OFA patella exam at 12+ months
• Hip evaluation — OFA or PennHIP radiographs at 24+ months
• Thyroid evaluation — Baseline thyroid panel at 2-3 years
• Dental assessment — Professional dental evaluation annually, with cleanings as recommended
• Airway assessment — Evaluation of nares and soft palate, ideally before age 2

Diet, Exercise, and Heat Sensitivity

Shih Tzus are prone to obesity, which worsens every condition they are predisposed to — particularly brachycephalic airway syndrome, patellar luxation, and dental disease. Most adult Shih Tzus need only 1/2 to 1 cup of high-quality food per day, split into two meals. Measure every portion carefully and account for treat calories. Dental-specific diets and dental chews can provide dual benefits of nutrition and oral hygiene.

Exercise requirements are moderate compared to working breeds. Two short walks daily (15-20 minutes each) plus indoor play provides adequate exercise for most Shih Tzus. Avoid exercising in heat or humidity — Shih Tzus are extremely heat-sensitive due to their compromised airways. They cannot pant efficiently to cool themselves, making heat stroke a serious and potentially fatal risk. Walk early morning or evening during warm months, always carry water, and know the signs of overheating: excessive panting, drooling, bright red tongue and gums, staggering, and collapse.

Air conditioning is not a luxury for Shih Tzus — it is a medical necessity during warm months. Cars heat up rapidly and are extremely dangerous; never leave a Shih Tzu in a parked car even briefly. Use a harness rather than a collar to avoid pressure on the already-compromised airway. Regular grooming (professional grooming every 4-6 weeks) maintains coat health and keeps the face clean to protect those vulnerable eyes.

When to See the Vet

Beyond routine checkups, see your veterinarian promptly if your Shih Tzu shows:

• Eye displacement or the eyeball appearing to protrude more than normal (emergency — proptosis)
• Squinting, tearing, redness, or cloudiness in either eye (possible corneal ulcer)
• Thick, mucoid eye discharge (possible dry eye/KCS)
• Increased snoring, labored breathing, or blue-tinged gums (airway deterioration)
• Signs of heat distress: excessive panting, drooling, bright red tongue
• Intermittent hopping or skipping on a hind leg (possible patellar luxation)
• Bad breath, bleeding gums, difficulty eating, or pawing at the mouth
• Head shaking, ear scratching, or foul odor from ears

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