7 Shih Tzu Common Health Issues [+Signs and Prevention]

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Shih Tzus, or Lion Dogs, are generally healthy but predisposed to some health conditions.

Understanding the genetics and common issues of this breed can prepare you for potential challenges your furbaby could face. In some cases, you may be able to prevent particular problems.

Remember, however, that a predisposition is not a guarantee. Your dog won’t necessarily suffer from any of the common conditions. Most canines have one or more health issues in their lifetime, and the list we’ll discuss is more common in Shih Tzus than most breeds.

The most common Shih Tzu health issues include brachycephalic syndrome, orthopedic issues, eye issues, ear infections, dental issues, and liver/kidney problems.

In this article, we’ll look at 7 common health issues of Shih Tzu, when they usually occur across the life cycle, and how Shih Tzu’s health compares with other dog breeds. We’ll finish with a list of health signs you need to watch out for and offer some tips for general healthcare and prevention.

Common health problems

While Shih Tzus from reputable breeders are generally healthy and have a life expectancy of 10-16 years, it helps to know about common conditions in the breed such as eye issues, dental issues, and orthopedic issues. That way, you’ll know how to recognize signs of a health condition and seek treatment early.

Brachycephalic syndrome

Over time, Shih Tzus have undergone selective breeding to develop a flat-faced appearance. This anatomical characteristic predisposes your furbaby to a condition known as Brachycephalic Obstructive Airway Syndrome(BOAS). Features of BOAS include:

  • Small nostrils
  • Narrow windpipe
  • Elongated soft palate
  • Collapsing trachea

The structural features make it harder for affected dogs to breathe and increase the likelihood of overheating. Flat-faced breeds, including Shih Tzus, Pugs, and English/French Bulldogs, are predisposed to BOAS. Their short skull and snout set them up for issues like exercise intolerance and snoring.

Shih Tzus are born with the anatomy, but the symptoms of BOAS usually become more evident later in life. Signs include:

  • Coughing
  • Difficulty breathing
  • Noisy breathing/snoring
  • Exercise intolerance
  • Gagging
  • Pale gums
  • Collapse

When Shih Tzus have mild symptoms of BOAS, they can usually be managed medically. However, dogs with more pronounced anatomy may need surgical correction. Without appropriate treatment, your furbaby may experience worsening symptoms with respiratory distress and potential collapse.

You can help prevent your Shih Tzu from developing BOAS symptoms by limiting time outdoors when it’s hot and humid, preventing your furbaby from reaching his ideal weight, and limiting your dog’s exercise/exertion.

Eye Conditions

Partly due to their flat face and large eyes, Shih Tzus tend to suffer from eye conditions including:

  • Pigmentary keratitis – corneal inflammation from other conditions can cause inflammation and pigmentation of the cornea
  • Keratoconjunctivitis sicca(dry eye) – insufficient tear production
  • Cherry eye – protruding third eyelid
  • Proptosis – eyeball bulges out and dislodges from the socket
  • Corneal ulcers – erosion of the corneal surface
  • Distichiasis – eyelashes/cilia grow inward and irritate the surface of the eye

Brachycephalic breeds like Shih Tzus, Pugs, and French Bulldogs can suffer from eyelid issues like distichiasis and cherry eye. They also tend to have poor tear production which leads to dry eyes. Long term, these conditions can cause corneal ulcers.

Shih Tzus are born with distichiasis and shallow eye sockets, so corneal ulcers, keratoconjunctivitis sicca, and proptosis can occur at any age. However, many take time to develop and are more likely to manifest in adulthood or the senior years.

With distichiasis, the eyelashes grow inward and irritate the surface of your dog’s eye, which can cause ulceration. When the ligaments that hold the tear gland into place weaken, the gland can pop out and swell, resulting in cherry eye. The bulging tissues may interfere with tear production,  resulting in dry eye. Corneal ulceration can occur when inadequate tear production or cherry eye causes dry eyes.

Symptoms of these eye conditions include:

  • Squinting
  • Light sensitivity
  • Blinking or holding the eye shut
  • Eye redness
  • Yellow or green eye discharge
  • tearing(except dry eye)
  • pinkish/red mass in the corner of the eye(cherry eye)

Without treatment, distichiasis, dry eye, and cherry eye can cause your dog’s eyes to ulcerate or develop pigmentary keratitis. If left alone, ulcers cause eye damage and potential blindness.

Most of the above conditions are genetically linked and challenging to prevent. However, corneal ulcers may be preventable if you treat underlying conditions. Additionally, proptosis may be prevented by discouraging your Shih Tzu from engaging in rough play.

The treatments for cherry eye, distichiasis, and proptosis involve surgery. Dry eye, pigmentary keratitis, and corneal ulcers are usually treated medically with antibiotic and/or anti-inflammatory treatments.


Cataracts are another eye condition that commonly affects Shih Tzus. It’s usually hereditary in the breed and is characterized by a hardening and cloudiness of the lens.

Any dog can develop cataracts, but breeds like Shih Tzus, American Cocker Spaniels, Labrador Retrievers, and Yorkshire Terriers are more prone to hereditary cataracts. In Shih Tzus, the condition usually manifests when they’re 8 years or older.

With cataracts, the lenses harden in your Shih Tzus eyes. As they set, they become cloudy and block the passage of light and images through the eye to the retina. Small cataracts minimally affect your dog’s vision, but larger ones can cause blindness.

You can recognize cataracts in your Shih Tzu as a cloudy or milky film over the eye. They may start as spots that spread or appear as general cloudiness.

Preventing hereditary cataracts in Shih Tzus is difficult, but you can promote healthy vision and eyes by feeding your furbaby quality food that’s rich in omega fatty acids. Limiting your dog’s exposure to UV rays by keeping him in the shade when outdoors can also protect against eye damage that may lead to cataracts.

If cataracts are left untreated, they usually progress from bad to worse and trigger inflammation and glaucoma. Treatment is surgical.

Orthopedic issues

Shih Tzus commonly suffer from luxating patellas and hip dysplasia. Both involve congenital conditions that result in loose joints.

Small dogs, including Shih Tzus, Maltese, and Chihuahuas, commonly suffer from luxating patellas. Hip dysplasia can occur in Shih Tzus, French Bulldogs, and large or giant breeds.

When Shih Tzus suffer from these orthopedic conditions, they’re born with an anatomical abnormality that predisposes them to extra movement in a joint. With luxating patellas, the kneecap moves out of its normal groove because the ligament attachment is not properly centered on the shinbone. Dogs with hip dysplasia have shallow hip sockets.

Dogs are born with an anatomy that predisposes them to luxating patellas or hip dysplasia. With luxating patellas, you may see occasional limping or skip-hopping at any age. However, with both conditions, signs of degenerative arthritis and pain can develop later in life.

If Shih Tzus are born with a shallow hip socket or predisposition for luxating patellas, the bones move too freely and irritate the joint cartilage, causing inflammation. Inflammation breaks down healthy cartilage over time, which results in degeneration and pain.

Symptoms of hip dysplasia, luxating patellas, and arthritis include:

  • Intermittent limping or skipping(luxating patella)
  • Holding one hind leg off the ground(luxating patella)
  • Cracking/popping sound when bending the affected knee(luxating patella)
  • Difficulty walking
  • Difficulty rising
  • Difficulty or reluctance when climbing stairs, getting in the car, or getting on furniture
  • Chronic pain
  • Sensitivity to touch around the hip joint
  • Swaying gait

Without treatment or medical management of these conditions, repeated joint irritation causes inflammation and degeneration. Over time, your dog will become more painful and lose mobility over time. 

Preventing degenerative arthritis from luxating patellas and hip dysplasia in your Shih Tzu includes weight management, joint supplementation with Glucosamine and Chondroitin, and purchasing your puppy from a breeder that screens for the condition.

Depending on the severity of your Shih Tzu’s condition, there are medical and surgical strategies to treat these conditions. Medical management includes physical therapy, joint supplements, restricted activity, weight reduction, anti-inflammatory drugs, and joint fluid modifiers.

Ear infections

The floppy nature of Shih Tzu ears results in less airflow and hair growth in the ear canal. These features set your furbaby up for trapped moisture and ear infections.

Ear infections are a common malady in Shih Tzus, French Bulldogs, Basset Hounds, and Beagles. They can appear at any point in your furbaby’s lifetime.

When the hairs in the ear canal collect moisture and dirt, bacteria or yeast can grow, causing infections. As the microbes increase, the ear becomes red, inflamed, and itchy or painful.

Signs of ear infections in your Shih Tzu include:

  • Scratching at the ears
  • Reddened ears
  • Painful ears
  • Dark ear discharge
  • A foul odor coming from the ear

Without proper treatment, ear infections in your Shih Tzu can fester and cause balance problems, neurological issues, eardrum rupture, pain, and deafness.

To prevent ear infections in your Shih Tzu, check and clean his ears at least every other week. Use a pet-safe ear-cleaning product.

If your furbaby gets an ear infection, your vet can swab the discharge and prescribe an appropriate topical antimicrobial medication to treat the condition.

Dental issues

Shih Tzus have small mouths with crowded teeth. As a result, they can have crooked teeth, gum disease, and tooth decay

Flat-faced breeds, including Shih Tzus, pugs, and boxers, are predisposed to developing periodontal disease and tooth decay. Other susceptible breeds include Collies, Chihuahuas, and Dachshunds.

Your Shih Tzu is born with a small, crowded mouth and may develop tooth decay or periodontal disease at any age. However, the condition is more common once your furbaby reaches early adulthood. According to Cornell College of Veterinary Medicine, 80-90% of dogs over 3 years old will have some periodontal disease.

As in humans, food residue in dogs’ mouths causes plaque and tartar formation. Eventually, this leads to infection around the teeth and gum line. The disease can damage the gums, bones, and ligaments, causing tooth decay and tooth loss.

 Signs of periodontal disease include:

  • Bad breath/halitosis
  • Red, inflamed gums
  • Receding gums
  • Gums bleed easily when touched, or teeth are brushed
  • Excessive drooling
  • Bloody saliva
  • Discolored teeth that appear yellow or brown
  • Pawing at the mouth

When periodontal disease goes untreated, it can lead to tooth decay and loss. The infections may also spread to other body systems.

Preventative methods for periodontal disease include annual oral exams by your veterinarian and daily brushing using veterinary-approved dog toothpaste. You should also schedule routine professional cleaning as recommended by your vet.

Treatment for periodontal disease varies depending on the severity of the condition. Minor cases can be handled with a professional dental cleaning. More advanced stages require deep cleaning and antibiotic gel application or tooth extraction.

Liver/Kidney problems

Shih Tzus can suffer from hereditary kidney diseases, glomerulonephropathy, and renal dysplasia.  They can also be born with a portosystemic shunt(PSS) that causes the bloodstream to bypass the liver, thus preventing the filtering of toxins.

Congenital diseases of the kidneys can occur in Shih Tzus, Lhasa Apsos, English Springer Spaniels, and others. With PSS, Shih Tzus, Miniature Schnauzers, Yorkshire Terriers, and Irish Wolfhounds may have a higher risk of disease.

As congenital conditions, PSS, renal dysplasia, and glomerulonephropathy usually appear in young dogs around 6 months to 2 years old, but mild conditions may not be noticeable until later. 


Dogs with glomerulonephropathy have kidneys with clogged or inadequate filtration systems. As a result, they tend to leak protein and can develop kidney disease. With renal dysplasia, the part of the kidney that produces urine is malformed. Portosystemic liver shunts cause the bloodstream to bypass the liver. As a result, metabolic toxins are not filtered from the blood.

Symptoms of problems with these filtering organs include:

  • Weight loss
  • Increased urination
  • Vomiting
  • Increased thirst
  • Stunted growth
  • Fatigue/lethargy
  • Blood in urine(kidney)
  • Ataxia or seizures(liver)

Without treatment, glomerular disease and renal dysplasia can progress to chronic kidney disease or kidney failure. If you don’t seek treatment for PSS in your Shih Tzu, toxins can build up in the bloodstream and cause neurological signs, severe illness, and death.

These liver and kidney conditions are inherited or present at birth, so there’s no way to prevent them. However, you can work with reputable breeders that don’t breed dogs with a history of these issues.

Treatment for glomerular disease and renal dysplasia includes dietary modification, oral medications, and possible dialysis. Surgical correction is the treatment of choice for a PSS.

Shih Tzu Health issues across the lifecycle

Certain conditions like BOAS and hip dysplasia aren’t usually evident until adulthood. However, congenital abnormalities can manifest in the puppy stage.

Shih Tzu Puppy Health Issues

In some cases, Shih Tzus are born with congenital abnormalities that cause problems. When congenital defects affect the kidney, you frequently see signs of illness during the puppy stage. You may also see your puppy limping if he has luxating patellas.

Adult Shih Tzu Health Issues

Although linked to congenital abnormalities or your Shih Tzu’s anatomy, many conditions take time to develop and manifest. Eye conditions like dry eye and corneal ulcers usually don’t manifest until adulthood. Ear infections, symptoms of BOAS, and dental issues are also more likely to appear after your pooch is mature. Symptoms of PSS usually surface around 6 years of age.

Senior Shih Tzu Health Issues

While cataracts can begin earlier in life, they tend to grow progressively worse. Vision impairment and blindness usually won’t appear until the senior years.

Orthopedic conditions also cause progressive joint degeneration. If you don’t notice your Shih Tzu limping or skip-hopping due to a luxating patella, you may not realize he has a problem with his knees or hips.

Shih Tzu Health Issues and Average Lifespan

Overall, Shih Tzus tend to be healthy dogs that usually live 10-18 years(average 13). 

Because they often enjoy long lives, they frequently die due to age-related health issues like kidney or liver failure, degenerative arthritis, and heart disease. 

Tooth loss from dental issues and periodontal disease can lead to difficulty eating and weight loss as your Shih Tzu ages. Finally, BOAS can place stress on your furbaby’s body and affect his overall health. Eventually, his quality of life may decline until you choose humane euthanasia.

Shih Tzu Health Issues VS Other Dog Breeds

Shih Tzus usually have fewer genetically triggered issues than the French Bulldog and other flat-faced breeds, but they can suffer from BOAS. When compared with large and giant-breed dogs, the Shih Tzu tends to have a longer average life span of around 13 years.

Health Signs Shih Tzu Parents Should Beware Of

Although Shih Tzus are generally healthy dogs, they can have some issues. It helps to know the signs you should watch for so that you can seek veterinary help when your dog needs it.

  • Coughing/gagging or difficulty breathing may point to BOAS
  • Exercise intolerance/overheating and pale gums can also be signs of BOAS
  • Light sensitivity, blinking, or squinting can point to an eye condition
  • Redness, discharge, or eye tearing can also occur with inflamed eyes
  • A small red mass in the corner of the eye could be a cherry eye.
  • A white spot or cloudiness in the pupil may point to a cataract.
  • LImping, skipping, a stiff or wobbly gait, or unwillingness to move can indicate orthopedic problems
  • Increased urination and thirst may be linked to kidney or liver problems
  • Dropping food, excessive drooling, pawing at the mouth, or inflamed gums may mean periodontal disease
  • If your Shih Tzu is shaking his head or scratching continually, he may have an ear infection
  • Vomiting and lethargy are common signs of illness in many conditions

Shih Tzu Health Care Tips and Prevention

Although Shih Tzus are fairly healthy, they can develop some health problems. You can minimize the risk of issues by caring for your furbaby’s health and taking some preventative measures.  

Select a reputable breeder

When you choose a breeder, select one with a reputation for breeding dogs with good genetics. He should be able to describe the parents’ health backgrounds. 

Schedule routine health checks

If your Shih Tzu is healthy, schedule an exam and routine health care with the vet at least once a year. If your furbaby develops a health condition, more frequent visits may be needed.

Maintain a healthy weight

Pay close attention to your Shih Tzu’s diet. Some conditions like BOAS and degenerative joint disease are worse when dogs are overweight. Depending on your furbaby’s size, she should weigh between 9 and 16 pounds. 

Feed a balanced diet

 Choose a diet with the proper balance of essential nutrients and feed your furbaby food that helps encourage a healthy weight. Consult with your veterinarian about diets to support the liver and kidneys if your dog has issues with these organs.

Give supplements

Consult with your veterinarian about appropriate supplements to encourage healthy digestion, joints, and skin. You may want to give your dog glucosamine, chondroitin, vitamin E, and probiotics.

Groom your Shih Tzu

Use regular grooming practices to encourage a healthy coat, skin, and ears. 

  • Bathe your Shih Tzu weekly bathing
  • Brush her coat a few times a week to avoid matting 
  • Check and clean your furbaby’s ears routinely to remove trapped debris
  • Trim hair around the eyes or pull it up with a tie to prevent it from irritating the eyes
  • Clean the eyes to remove tear staining

Use an orthopedic bed

Get an orthopedic bed with supportive memory foam for your furbaby if he suffers from an orthopedic condition. These beds provide support and cushioning to ease your pup’s aches and pains.

The Final Woof

Shih Tzus tend to be fairly healthy dogs that often live 10-18 years. Due to their flat face and selective breeding, they can suffer from certain health issues. Common health problems in the breed include BOAS, liver/kidney problems, dental issues, orthopedic issues, and eye problems. 

Understanding the common health issues and their symptoms in Shih Tzus can help you to recognize and address problems when they arise. Of course, your pup may not suffer from any of the conditions we discussed. It’s good to be prepared and know what measures you can take to try to reduce the risk of issues and support your furbaby’s overall health.

Photo of author
Dr. Libby Guise earned her DVM from the University of Minnesota in 1994. After working in private practice in Wisconsin for two years, she joined the USDA as a Veterinary Medical Officer. In 2011, Libby came home to focus on raising and teaching her adoptive daughter. She lives in Wisconsin with her daughter, husband, and two furbabies: Charis, a lab-mix rescue pup, and Chesed, a Springer Spaniel.

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