Common Shih Tzu Health Issues: How to Identify Prevent, and Manage Them Effectively

Every dog breed—and every dog!—is loved for its unique traits. But these same characteristics, from anatomical structure to genetic makeup, can also make certain breeds more prone to specific health issues. Shih Tzus, with their lovable personalities and distinctive features, are no exception. Understanding potential Shih Tzu health issues and knowing what to look for can help keep your pup healthy and happy for years to come.

A Beloved Breed: An Overview of Shih Tzus

Originally believed to be from Tibet, Shih Tzus became beloved companions in Chinese imperial courts, especially during the Ming Dynasty. Some were even featured in palace art, and their breeders were often rewarded by emperors with gifts and land.

In the 19th century, other breeds—like the Pug and Pekingese—started gaining more popularity than Shih Tzus. The breed’s future became even more uncertain after the 1949 Communist Revolution, when dogs linked to royalty were nearly wiped out in China. 

Fortunately, various breeding programs maintained the Shih Tzu breed. Some were eventually smuggled out and brought to Scandinavia and England. All modern Shih Tzus actually descend from just 13 dogs that made it out of China. Traveling American soldiers helped introduce them to the U.S., and by 1969, the breed was officially recognized by the American Kennel Club.

Today, Shih Tzus are adored for the same reasons they once charmed emperors: known for their affectionate nature, compact size and long, flowing coats. Their friendly and playful demeanor makes them wonderful companions, and their expressive eyes and pushed-in faces give them an endearing quality.

However, some of these same traits can also contribute to known Shih Tzu health issues. For instance, their shallow-nosed face structure can lead to breathing difficulties, small mouths can predispose them to dental problems and floppy ears can make ear infections more common.

Exploring the Most Common Shih Tzu Health Issues

Most Shih Tzus live long, happy lives with no major health problems—especially when they’re well cared for and see their veterinarian regularly. But like all breeds, Shih Tzus can be prone to certain conditions due to their unique build and genetics.

Brachycephalic Obstructive Airway Syndrome (BOAS)

Shih Tzus’ short skull shape can contribute to BOAS, a condition that makes it more difficult for them to breathe normally. Their narrow nostrils, elongated soft palates, extra tissue in the back of the throat and other airway abnormalities can cause noisy breathing, snorting and exercise intolerance.

To reduce the risk of BOAS complications, it’s important to properly manage your dog’s weight, avoid overly strenuous activities and to limit heat exposure since symptoms can worsen in high humidity or hot temperatures. Aside from managing the condition, some veterinarians may recommend corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs) or oxygen therapy.  In some cases, surgery may be needed to correct anatomical issues and improve breathing.

Eye Problems

Due to their shallow eye sockets and genetic predisposition, Shih Tzus can experience several eye conditions, including:

• Cataracts: Cloudy lenses that impair vision and may require surgical removal.
• Proptosis: A sudden displacement of the eyeball, often caused by trauma.
• Corneal Ulcers: Painful sores on the surface of the eye caused by injury or irritation.
• Cherry Eye: Prolapsed tear glands that appear as a red lump in the corner of the eye.
• Progressive Retinal Atrophy: A degenerative disease that leads to gradual vision loss.

Symptoms to watch for vary by disease but can include redness, cloudiness, excessive discharge or your dog pawing at their eyes. If you notice signs of potential eye problems, get in touch with your veterinarian right away. Quick care is key to preventing permanent damage or vision loss. To prevent irritation, try to keep your Shih Tzu’s eye area clean and provide regular grooming—especially trimming the hair around their eyes.

Ear Infections

With their floppy ears and long hair, ear infections are one of the most common Shih Tzu health issues. These characteristics can create a warm, moist environment ideal for bacteria or yeast to grow. Symptoms of an ear infection include head shaking, scratching at the ears, redness, swelling and foul odor.

To prevent ear infections, consider regularly cleaning your dog’s ears with a veterinarian-approved solution and keep them dry after baths or swimming. If an infection occurs, your veterinarian may prescribe medicated drops or oral antibiotics to clear it up.

Hip Dysplasia

Though it’s more commonly associated with larger breeds, Shih Tzus can also suffer from hip dysplasia—a malformation of the hip joint that can cause discomfort, arthritis and limited mobility.

Signs include difficulty getting up, limping, reluctance to jump or climb stairs and a bunny-hopping gait. A healthy diet, joint supplements and controlled exercise can help manage symptoms. Some veterinarians may prescribe NSAIDs to provide pain relief. In more severe cases, surgery may be necessary.

Dental Disease

Small mouths and crowded teeth make Shih Tzus particularly prone to dental problems. Without regular care, plaque and tartar build up and lead to gum disease and tooth loss.

Some common dental conditions in Shih Tzus include:

• Periodontal Disease: Inflammation and infection of the tissues surrounding the teeth, which can cause pain, gum and bone loss and even secondary bacterial infections.
• Malocclusion: Misalignment of the teeth—often noticed as an underbite or overbite—which can make chewing difficult and cause trauma to the soft tissues.
• Loose Teeth: The periodontal ligament deteriorates as small dogs age. Plus, Shih Tzus are particularly prone to loosening teeth at the front of their mouths. 
• Delayed Tooth Eruption: A condition where a Shih Tzu’s teeth do not erupt from their gums in a normal timeframe, which can cause cysts or impaction.

In general, signs of dental problems include red or swollen gums, bad breath, trouble chewing and tooth loss. Regular veterinary dental cleanings and daily tooth brushing at home can go a long way in preventing these issues.

Luxating Patella

Common in many small breeds, this condition occurs when a Shih Tzu’s kneecap slips out of place. It can affect just one or both of their knees. In most cases, the kneecap shifts inward rather than outward, which is called medial patellar luxation (MPL). 

While some Shih Tzus show no signs of a luxating patella, others may exhibit signs of discomfort. You may notice yelps from pain, holding their hindlimbs off the ground, an abnormal gait, intermittent limping, a hunched bank or even clicking or popping sounds from their joints. 

Treatment for this may include weight management, joint supplements, restricted activity, anti-inflammatory medications, and in some cases, surgery to correct the alignment.

Hypothyroidism

Hypothyroidism happens when the thyroid gland doesn’t produce enough hormones. Most often, it is diagnosed when a dog is middle-aged. It’s not curable, but it’s manageable. Common symptoms in Shih Tzus include weight gain, lethargy, thinning fur and getting cold easily.

With proper diagnosis, your vet can prescribe daily thyroid hormone replacement therapy to maintain healthy function and energy levels.

Glomerulonephritis

This inherited kidney disease causes inflammation and poor kidney function, leading to toxin buildup in the body. Signs include increased thirst or urination, lethargy and vomiting. Dogs between ages 4-8 are most likely to show symptoms of glomerulonephritis.

Treatment options include immunosuppress, anti-clotting agents, angiotensin-converting enzyme (ACE) inhibitors, blood pressure medications, omega-3 fatty acid supplements and dietary changes, depending on the underlying cause of your dog’s glomerulonephritis.

Liver Shunts (Portosystemic Shunts)

Shih Tzus are predisposed to liver shunts, which occur when blood bypasses the liver, preventing it from filtering toxins and metabolizing nutrients. Affected dogs may show signs like stunted growth, poor appetite, increased thirst and urination, vomiting, diarrhea, unsteadiness and other behavioral changes. It usually develops before dogs reach 3 years of age.

Treatment may involve surgical correction of the shunt, along with a specialized low-protein diet to support liver function and medications. Specifically, your veterinarian may prescribe antibiotics to reduce gut bacteria, or they may recommend enemas that help remove bacteria.

Obesity

Obesity is one of the most common yet preventable issues for Shih Tzus. Overfeeding and a sedentary lifestyle are the main culprits. In general obesity is defined as being 10-20% above an optimal body weight. Shih Tzus can range from 9-16 pounds, depending on their age and sex. Your veterinarian can provide personalized recommendations for a healthy weight.

Excess weight can reduce life expectancy and make Shih Tzus more prone to diabetes, orthopedic conditions, cancer and other diseases. It can also exacerbate respiratory problems, joint issues, heart conditions and more. 

To prevent obesity and the other Shih Tzu health issues associated with it, consider:

• A well-balanced diet based on age and activity level
• Controlled portion sizes
• Limited high-calorie treats
• Daily walks or light play sessions to promote fitness

The Role of Prevention in Shih Tzu Health Issues

The best way to safeguard against Shih Tzu health issues is through awareness and preventive care. Routine veterinary visits allow for early detection of issues, which means faster intervention and better outcomes. Here are additional preventive steps you can take:

• Vaccinations and Parasite Prevention: Keep your pup up to date on core and lifestyle vaccines. Use monthly flea, tick and heartworm preventatives to avoid parasite-related illnesses.
• Proper Diet and Exercise: Choose high-quality dog food suited for your dog’s age and needs, and provide regular, gentle exercise to support weight and joint health.
• Supplements: Glucosamine, omega-3 fatty acids and probiotics are among the options that can be beneficial. Talk to your veterinarian before starting any supplements.
• Regular Grooming: Keep your Shih Tzu’s coat trimmed and clean, especially around the face, ears and paws. This prevents matting, infections and skin irritations.
• At-Home Care: Brush your Shih Tzu’s teeth daily, clean their ears weekly, monitor their weight and observe any changes in their behavior or appearance.

Trusted Treatment Options for Shih Tzu Health Issues

Your Shih Tzu is more than a pet—they’re family. With early awareness, preventive care and the right treatment plan, you can help them live a long, happy and healthy life. At Mixlab, we’re here to help you stay ahead of Shih Tzu health issues with trusted, convenient treatment options. In fact, Shih Tzus are one of the top breeds we dispense medications for!

Whether your dog needs prescription medication, over-the-counter treatments, supplements or special diets, Mixlab offers a full range of options tailored to your pet’s needs. Many medications can be compounded into specific dosages and forms, like small, tasty chew treats—making it easier than ever to give your dog the care they deserve. Best of all, we offer free next-day delivery right to your doorstep. Simply place your order online or reach out to our friendly team for help.