Shih Tzu Health Guide
Everything shih tzu owners need to know about keeping their dog healthy.
Breed Overview
The Shih Tzu is a small companion breed developed from Tibetan and Chinese toy dogs and recognized by the AKC in 1969. They are typically affectionate, playful, and people-oriented, with exercise needs that are modest compared with many other breeds. What makes the breed medically unique is its brachycephalic head shape, prominent eyes, dense coat, and small size—traits that increase the risk of breathing trouble, eye disease, dental crowding, and orthopedic problems such as patellar luxation. Because many Shih Tzus live well into their teens, long-term preventive care matters more than quick fixes.
Common Health Issues
Brachycephalic airway syndrome
Shih Tzus can have narrowed nostrils, elongated soft palate, and other upper-airway changes that make breathing harder, especially in heat or during exercise. Warning signs include noisy breathing, gagging, exercise intolerance, overheating, or blue-tinged gums. Mild cases may be managed with weight control and avoiding heat stress; more severe cases may need surgery. Seek urgent veterinary care for labored breathing or collapse.
Eye disease and irritation
Their large, prominent eyes and facial hair make Shih Tzus prone to corneal irritation, ulcers, abnormal lashes, pigmentary keratitis, and other surface eye problems. Squinting, redness, rubbing the face, cloudiness, discharge, or keeping an eye closed should be treated as same-day veterinary issues because eye injuries can worsen quickly.
Dry eye (KCS)
Keratoconjunctivitis sicca is seen more often in some small, flat-faced breeds, including Shih Tzus. Tear deficiency can cause thick discharge, redness, discomfort, recurrent infections, and corneal damage. Diagnosis usually involves a tear test and eye exam. Ongoing treatment is often needed, so early diagnosis helps protect vision.
Patellar luxation
This breed is predisposed to kneecaps that slip out of place. Signs can include skipping, hopping, sudden yelps, stiffness, or reduced willingness to jump. Mild cases may be monitored, but painful or more advanced cases can require surgery. Breeding dogs should have patellar evaluations recorded with OFA.
Periodontal disease
Like many toy breeds, Shih Tzus are at increased risk for crowded teeth and periodontal disease. Bad breath, tartar, red gums, chewing changes, and loose teeth are common clues. Preventive dental care, including home brushing and professional cleanings when recommended, is especially important in this breed.
Inherited liver, kidney, hip, and heart concerns
The American Shih Tzu Club specifically encourages breeders to review lines for renal dysplasia, portosystemic shunt, hip dysplasia, genetic eye disease, patellar luxation, and cardiac issues. Depending on the dog’s age and symptoms, your veterinarian may recommend bloodwork, bile acid testing, imaging, orthopedic assessment, or cardiology follow-up.
Preventive Care Schedule
Shih Tzus should follow your veterinarian’s core vaccination schedule, along with parasite prevention and annual wellness exams. Breed-specific prevention usually centers on four areas: airway, eyes, teeth, and knees. Ask your vet to listen for upper-airway noise, assess heat tolerance, and help maintain a lean body condition because extra weight can worsen brachycephalic breathing. Eye checks should be prompt whenever you see redness, squinting, discharge, or rubbing, and breeding dogs should have ACVO eye exams registered with OFA. Patellar exams are part of recommended screening for breeding dogs, with optional OFA hip and cardiac evaluations. Dental care should start early: regular tooth brushing at home plus professional dental cleanings as recommended can help prevent the severe periodontal disease common in toy breeds.
When to Use Telehealth for Your Shih Tzu
Telehealth can be especially useful for Shih Tzu owners because many breed-related issues start with subtle signs that benefit from early triage. A virtual vet visit can help you decide how urgently your dog needs in-person care if you notice mild eye discharge, tear staining, sneezing, reverse sneezing, mild skin irritation under facial folds, coughing after grooming or excitement, dental questions, or changes in activity in a senior dog. Telehealth is also helpful for reviewing breeder health testing, discussing preventive screening questions, planning safe exercise during hot weather, and monitoring recovery after a recent diagnosis. However, breathing distress, an eye held shut, a blue tongue or gums, collapse, severe pain, seizures, or suspected heatstroke should always be treated as emergency in-person problems.
Shih Tzu Health FAQs
What health tests should a Shih Tzu breeder provide?
Are breathing problems normal in Shih Tzus?
Why do Shih Tzus have so many eye problems?
Do Shih Tzus really need professional dental care?
When should I see a vet instead of waiting at home?
Disclaimer: The information provided in this article is for educational purposes only and does not constitute veterinary medical advice. Reading this content does not establish a veterinarian-client-patient relationship. Every pet is different — always consult a licensed veterinarian before making decisions about your pet's health, diet, or care. If you'd like personalized guidance, you can talk to one of our vets. If your pet is experiencing a medical emergency, contact your local emergency animal hospital immediately.