Shih Tzu: Complete Health Issues Guide and Prevention Strategies

Shih Tzus are beloved companions known for their distinctive traits, but like all breeds, they have specific health vulnerabilities. This guide provides a thorough overview of common health issues, prevention strategies, and care recommendations for Shih Tzu owners.

BLUF: Shih Tzus are prone to a handful of breed-specific problems—brachycephalic airway issues, dental disease, eye disorders, patellar luxation, and skin allergies are the most common—but most problems can be reduced or managed with proactive grooming, regular veterinary screening, weight control, and early treatment. Consult your veterinarian promptly if you notice breathing difficulty, sudden eye pain, collapse, or major changes in eating or mobility.

Common health problems in Shih Tzus (what to watch for)

• Brachycephalic airway syndrome (BOAS): Narrow nostrils (stenotic nares), elongated soft palate, and hypoplastic trachea can cause noisy breathing, snoring, exercise intolerance, and heat sensitivity. Even mild BOAS can worsen with obesity and age. Avoid overheating—Shih Tzus can decompensate quickly in temperatures above 24°C (75°F) with high humidity. If you notice audible stertor/stridor, increased respiratory rate (>40–50 breaths/min at rest), or blue/pale gums, seek immediate veterinary care.
• Dental disease: Small breeds are predisposed to crowding and periodontal disease. The American Veterinary Dental College reports up to 80% of dogs show dental disease by age 3; Shih Tzus are commonly affected much earlier. Signs: bad breath, tartar, red gums, loose or missing teeth, reduced appetite.
• Eye problems: Prominent eyes and shallow sockets increase risk of corneal ulcers, dry eye (keratoconjunctivitis sicca, KCS), entropion/ectropion, and progressive pigmentary keratitis. Redness, excessive tearing, squinting, cloudiness, or any sudden eye pain are reasons for prompt veterinary ophthalmic evaluation.
• Orthopedic issues: Luxating patella (kneecap slipping) is common in small breeds and may present as intermittent skipping or inability to bear weight. Intervertebral disc disease (IVDD) can also occur—look for back pain, reluctance to jump, or hind limb weakness. Severe neurologic signs require emergency care.
• Skin and ear disease: Facial folds and floppy ears trap moisture and debris—chronic moisture can lead to dermatitis and otitis externa. Food and environmental allergies (atopic dermatitis) cause itching, recurrent ear infections, secondary skin infections, and hair loss.
• Less common but possible: hypothyroidism (middle-aged dogs), heart murmurs, and juvenile cataracts. Lifespan averages about 10–16 years; senior screening should intensify after about age 8.

Symptoms recognition and when to see a veterinarian

General rules

• Routine vet visit: at least annually for adult Shih Tzus; every 6 months for seniors (generally ≥8 years). Puppies: vaccine and wellness schedule (see prevention section).
• Call your vet: non‑urgent concerning changes such as gradual weight loss, chronic itching not responding to over‑the‑counter measures, or new lumps.
• See same‑day or emergency: breathing problems, collapse, severe vomiting/diarrhea (>24 hours or bloody), seizures, severe bleeding, inability to urinate/defecate, or inability to walk.

• Any sudden squinting, pawing at the eye, cloudiness, or discharge that is green/yellow—these can indicate a corneal ulcer or infection. Corneal ulcers can progress to perforation within 24–72 hours. Seek veterinary care same‑day.
• Excessive tearing with staining or persistent redness—arrange veterinary or ophthalmic exam within 48 hours.
• Eye bulging, sudden blindness, or severe pain—emergency visit.

• Marked noisy breathing with open‑mouth panting at rest, blue or pale gums, marked difficulty breathing, or fainting—this can indicate respiratory compromise and requires immediate emergency care (within minutes to hours).
• Heat stress signs (drooling, weak, collapse) in hot/humid weather—cool carefully and seek emergency care.

• Sudden limping that doesn’t improve in 24–48 hours, inability to bear weight, or paralysis—seek same‑day veterinary attention (IVDD or fracture possible).
• Chronic intermittent skipping or “bunny hopping” that progresses—schedule an orthopedic exam; patellar luxation severity is graded I–IV and management varies.

• Fever (>102.5°F/39.2°C), foul-smelling ears, or rapidly spreading redness/swelling—same‑day veterinarian consult.

• Do not give human NSAIDs, acetaminophen, or other medications without veterinary guidance—certain drugs are toxic to dogs. For any over‑the‑counter remedies or behavior changes, consult your veterinarian first.

Treatment options: medical, surgical, and supportive care

Respiratory (BOAS)

• Conservative: weight loss (aim for ideal body condition score 4–5/9), avoidance of heat/exertion, harness rather than neck collars, and management of upper respiratory infections.
• Surgical: corrective surgery can include widening stenotic nares (nares resection), shortening/reshaping an elongated soft palate, and removal of everted laryngeal saccules. Surgery improves quality of life in many dogs but does not eliminate all risks; anesthetic risk is higher in brachycephalics—consult your veterinarian and possibly a surgeon experienced with BOAS.

• Home: daily tooth brushing with canine toothpaste (ideally every day; minimum 3–4×/week), dental chews designed for tartar control, and water additives if approved by your vet.
• Professional: scaling and polishing under anesthesia. Frequency depends on disease severity—many Shih Tzus need dental cleanings every 6–12 months if early disease is present. Extractions are common for advanced periodontal disease.
• The AVDC recommends starting home dental care as soon as you bring the puppy home and discussing professional cleanings with your veterinarian.

• Corneal ulcers: topical antibiotics, pain control (e.g., topical atropine in some cases), and protective measures (Elizabethan collar). Deep ulcers or non‑healing ulcers may require surgical grafts.
• KCS (dry eye): topical cyclosporine or tacrolimus to increase tear production, artificial tears for lubrication, and routine monitoring.
• Entropion/ectropion and cherry eye: corrective surgery for anatomical issues.
• See a veterinary ophthalmologist for complex or recurrent cases.

• Patellar luxation: medical management (weight control, anti‑inflammatories, physical therapy) for mild cases; surgical correction for severe or recurrent luxations—procedures reshape the trochlear groove and realign tendons.
• IVDD: conservatively managed in some mild cases (strict rest, pain meds) but surgical decompression may be needed for severe neurologic deficits. Time to surgery matters—loss of deep pain sensation for more than 24–48 hours has a worse prognosis.

• Ear infections: topical cleaning and veterinarian-prescribed otic medications (antibiotics/antifungals/anti‑inflammatories) after cytology. Chronic cases may require culture and sensitivity.
• Allergies: elimination diet trials, allergen avoidance, antihistamines, corticosteroids for flare control (short term), and immunotherapy (allergy shots) for long-term control.

• Because of brachycephaly and small size, anesthetic risk is higher. Pre‑anesthetic bloodwork, temperature and airway planning, and experienced anesthesia protocols reduce risk. Discuss risks and benefits with your veterinarian—“consult your veterinarian” applies before scheduling elective procedures.

Prevention strategies and routine care (practical schedule and tips)

Vaccines & parasite control (typical schedule)

• Puppies: core vaccines typically start at 6–8 weeks and continue every 3–4 weeks until 14–16 weeks (distemper/parvovirus, adenovirus, parainfluenza). Rabies at 12–16 weeks (per local law).
• Boosters: 1 year after initial series, then every 1–3 years per vaccine and local guidelines.
• Heartworm prevention: monthly heartworm preventive year‑round in many regions; test annually.
• Flea/tick control: year‑round if in endemic area; discuss product choice with your veterinarian.

• Brush daily with canine toothpaste; start as a puppy if possible.
• Professional dental exam at least annually; cleaning under anesthesia as advised—many Shih Tzus require cleanings every 6–12 months.
• Early extractions prevent chronic infection that affects systemic health.

• Clean facial folds and under the chin daily with a damp cloth or pet‑safe wipe; dry thoroughly to prevent yeast/bacterial growth.
• Trim hair around eyes every 1–3 weeks to prevent corneal irritation.
• Bathing every 3–4 weeks is common for Shih Tzus with a full coat; adjust based on skin condition. Use hypoallergenic shampoos for allergy-prone dogs.
• Ears: inspect weekly and clean as advised (use vet‑approved ear cleaners); address wax/bad odor early.

• Maintain ideal weight (body condition score 4–5/9). Even a few pounds of excess weight increases respiratory effort and joint stress.
• Provide regular low‑impact exercise: short walks (10–20 minutes, 1–2 times/day) with rest breaks; avoid intense running and jumping especially in puppies <12 months (growth plates still maturing) and senior dogs.
• Use a harness, not a neck collar, to reduce tracheal pressure.

• Adult wellness: annual physical exam with baseline bloodwork; after age 8, semi‑annual checks including bloodwork and blood pressure.
• Ophthalmic exams: annually (or more often if problems) by your veterinarian or a veterinary ophthalmologist.
• Orthopedic checks: patella exam and hip palpation during puppy and young adult exams.
• If acquiring a puppy, choose breeders who screen for patellar luxation, ophthalmic disease (CERF/OFA eye exams or board-certified ophthalmologist evaluations), and who can show clear health records for parents. Avoid breeders who breed for extreme facial features aggravating BOAS.

• Daily: check eyes for redness/discharge; clean facial folds; check breathing at rest for new noise or increased rate; ensure water intake and appetite normal.
• Weekly: ear check and cleaning as needed; brush teeth or provide dental chew.
• Monthly: parasite prevention dosing; nail trim as needed.

Key Takeaways

• Shih Tzu health is manageable with proactive care: focus on airway management, dental hygiene, eye protection, and weight control to prevent the most common problems. Consult your veterinarian early for any concerns.
• Urgent signs include breathing difficulty, sudden eye pain/cloudiness, collapse, inability to walk, and severe bleeding—these require same‑day or emergency care.
• Preventive routine: daily facial and dental care, weekly ear checks, annual wellness exams (every 6 months for seniors), appropriate vaccinations, and year‑round parasite prevention.
• Choose a responsible breeder who screens breeding dogs for patella and eye issues; schedule specialist referrals when problems are recurrent or severe.
• When in doubt, contact your veterinarian—early diagnosis and treatment preserve quality of life and often reduce long‑term costs and complications.

Frequently Asked Questions

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