Shih Tzu Health Problems & Prevention

Shih Tzus are a generally hardy, long-lived toy breed — many live well into their mid-teens. But like all purebred dogs, they carry certain breed-specific health predispositions. Being informed about these conditions doesn't mean your puppy will develop them; it means you'll recognize early warning signs, ask your vet the right questions, and understand why choosing a health-focused breeder matters so much.

At Royal Shih Tzu Puppies, we've spent over 15 years breeding for health, temperament, and longevity. This guide covers the key health issues every Shih Tzu owner should understand.

Brachycephalic Obstructive Airway Syndrome (BOAS)

Shih Tzus are a brachycephalic breed — meaning they have a compressed skull that gives them their characteristic flat face and large, expressive eyes. While this look is part of their charm, it also comes with anatomical trade-offs: narrowed nostrils (stenotic nares), an elongated soft palate, a hypoplastic trachea, and sometimes everted laryngeal saccules. Together, these can restrict airflow significantly, a cluster called Brachycephalic Obstructive Airway Syndrome.

Symptoms range from mild — occasional snoring, snorting during exercise, or breathing loudly during sleep — to severe: labored breathing, exercise intolerance, gagging, and even collapse in extreme heat. Severely affected dogs may require surgical correction of the nostrils or soft palate.

Responsible breeding and veterinary care may help reduce some risks, but screening cannot guarantee that a dog will not develop a condition. Ask to review records for the individual parent dogs.

Eye Problems: Corneal Ulcers, Dry Eye & More

The Shih Tzu's large, prominent eyes are beautiful — and vulnerable. Because the eyes protrude more than in many breeds, they're more exposed to dust, debris, and accidental injury. The long facial hair of the breed can also wick directly onto the cornea, causing chronic irritation.

Eye pain, squinting, redness, tearing, or discharge warrants prompt veterinary evaluation. Contact a veterinarian to determine how urgently your dog should be seen.

Keratoconjunctivitis Sicca (KCS / Dry Eye) is a condition where the tear glands don't produce enough moisture. Signs include a thick, yellowish-green discharge, dull eyes, and frequent blinking. It's manageable with prescription eye drops but requires lifelong treatment.

Prevention tips: Keep the hair around the eyes trimmed or tied back. Wipe the corners of the eyes daily with a damp, clean cloth or pet-safe eye wipe. Avoid spraying grooming products near the face. Annual vet eye exams catch problems early.

Hip Dysplasia & Luxating Patellas

Hip dysplasia — a malformation of the hip joint where the ball and socket don't fit together properly — occurs in Shih Tzus, though less frequently than in large breeds. It causes pain, a swaying gait, reluctance to climb stairs, and arthritis over time.

Luxating patellas (kneecaps that slip out of position) are more common in toy breeds including Shih Tzus. Mild cases cause occasional skipping; severe cases cause lameness and may need surgery. Many Shih Tzus live comfortably with mild luxating patellas if kept lean and given joint supplements as recommended by their vet.

Responsible breeding and veterinary care may help reduce some risks, but screening cannot guarantee that a dog will not develop a condition. Ask to review records for the individual parent dogs.

Allergies & Skin Conditions

Shih Tzus are one of the more allergy-prone toy breeds. Allergies can be environmental (pollen, dust mites, mold) or food-related (often chicken, beef, wheat, or dairy). Symptoms typically manifest in the skin rather than respiratory symptoms — itching, licking paws, recurring ear infections, redness between toes, and hair loss.

Many cases are successfully managed by switching to a limited ingredient or novel protein diet (see our Shih Tzu feeding schedule for food quality guidance), using prescription antihistamines or immunotherapy, and keeping the living environment clean. Work with your vet to identify whether the trigger is food or environmental before making sweeping diet changes.

Dental Disease: The Most Overlooked Health Issue

Studies suggest that over 80% of dogs show signs of dental disease by age 3 — and small breeds like Shih Tzus are disproportionately affected. Their small mouths cause teeth to crowd and overlap, creating ideal conditions for plaque and tartar accumulation. Left untreated, bacteria from the mouth enter the bloodstream and can damage the heart, kidneys, and liver.

Prevention: Start brushing your Shih Tzu's teeth as a puppy so they accept it as normal — our complete grooming guide covers dental care alongside coat, ear, and nail maintenance. Aim for daily brushing with dog-safe enzymatic toothpaste. Supplement with dental chews, water additives, or dental toys. Budget for a professional dental cleaning under anesthesia every 1–2 years, starting around age 2–3.

Kidney Disease & Hypothyroidism

Renal dysplasia is a heritable condition where the kidneys develop abnormally. Affected dogs may show signs early in life (excessive thirst, poor growth, vomiting) or not until middle age. While there's no cure, dogs with mild renal dysplasia can live comfortable lives on a kidney-supportive diet and regular monitoring. Responsible breeders avoid breeding dogs from lines known to carry this condition.

Hypothyroidism — an underactive thyroid gland — is seen in Shih Tzus, though less commonly than in some other breeds. Signs include unexplained weight gain, lethargy, hair thinning, cold intolerance, and skin changes. It's easily diagnosed with a blood panel and managed with daily thyroid hormone medication. Annual wellness bloodwork helps catch it early.

How Responsible Breeding May Help Reduce Risk

The single most impactful thing you can do for your Shih Tzu's health starts before you even bring them home: choosing a breeder who prioritizes health over profit. At Royal Shih Tzu Puppies, we've spent over 15 years selecting breeding pairs based on health, structure, and temperament — not just coat color or availability.

Our puppies receive a full veterinary examination, age-appropriate vaccines (see the complete Shih Tzu vaccination schedule), and deworming before going home. Every puppy is backed by our 2-year genetic health guarantee. We're happy to discuss the health history of both parent dogs and answer any questions you have about our breeding program.

The healthiest Shih Tzus come from breeders who are selective, transparent, and genuinely care about where their puppies end up. That's been our commitment since day one.