Shih Tzu Health Issues: The Complete Guide to Common Conditions
[Published: August 19, 2026 | Last updated: August 19, 2026] | 10 min read
TL;DR
- Shih Tzus are prone to breathing problems, eye disease, dental disease, and spinal issues, mostly because of their flat face, long back, and prominent eyes.
- A UK primary-care study of 2,423 Shih Tzus found skin disorders (16.6%), dental disease (13.3%), and eye disorders (11.9%) were the three most diagnosed conditions (O'Neill et al., 2024).
- The same study put median age at death at 12.7 years, with poor quality of life, heart disease, and enteropathy as the leading causes of death (O'Neill et al., 2024).
- Intervertebral disc disease (IVDD) affects an estimated 3.5-5% of Shih Tzus over their lifetime, roughly 10 to 12 times the rate seen in non-chondrodystrophic breeds (Ello Pet Health, 2026).
- Most Shih Tzu health problems are manageable with early detection, so routine vet checks matter more for this breed than for many others.
What Is a Shih Tzu, and Why Is the Breed Prone to Health Problems?
A Shih Tzu is a toy breed developed in China, built low to the ground with a short muzzle, large round eyes, and a long flowing double coat. Those traits are exactly what predispose the breed to its most common health problems.
The flat face creates airway restrictions. The long back and short legs come from a form of dwarfism called chondrodystrophy, which speeds up spinal disc degeneration. The prominent eyes sit more exposed than in longer-nosed breeds, raising injury and infection risk. The long coat and floppy ears trap moisture, feeding skin and ear infections.
A cross-sectional survey of UK Kennel Club-registered Shih Tzus found that 39.6% had at least one reported disease or condition (O'Neill et al., 2024). That does not mean a Shih Tzu is destined for poor health. It means owners benefit from knowing what to watch for and catching problems early.
How Common Are Health Problems in Shih Tzus?
Skin, dental, and eye disorders are the three most frequently diagnosed conditions in Shih Tzus, according to primary-care veterinary records from the UK.
| Condition Category | Prevalence | Source |
|---|---|---|
| Cutaneous (skin) disorders | 16.6% | O'Neill et al., 2024 |
| Dental disorders | 13.3% | O'Neill et al., 2024 |
| Ophthalmological (eye) disorders | 11.9% | O'Neill et al., 2024 |
| Ear disorders | ~6% | Forbes Advisor, 2026 |
| IVDD (lifetime risk) | 3.5-5% | Ello Pet Health, 2026 |
Shih Tzus also showed a higher rate of anal sac impaction, umbilical hernias, and eye problems than dogs overall, which suggests a breed-specific predisposition rather than random chance (O'Neill et al., 2024). Median age at death was 12.7 years, and a separate UK longevity study put average life expectancy at 11.05 years, which is close to the average for UK dogs overall (O'Neill et al., 2024).
Breathing Problems: Brachycephalic Obstructive Airway Syndrome (BOAS)
BOAS is a progressive condition caused by the short-skull shape shared by Shih Tzus, pugs, and bulldogs, and it can restrict a dog's ability to breathe normally at rest or during exercise (University of Cambridge Department of Veterinary Medicine).
The syndrome comes from a mismatch between a shortened skull and the amount of soft tissue that still has to fit inside it. Narrow nostrils, an elongated soft palate, and extra tissue in the throat combine to partially block airflow (Today's Veterinary Practice, 2026).
Watch for noisy breathing, snorting, snoring, exercise intolerance, and gagging or retching, especially in heat or after activity. Weight management, avoiding strenuous exercise, and limiting heat exposure all reduce the chance of a breathing crisis. Dogs with moderate to severe BOAS often need surgery to widen the nostrils or shorten the soft palate.
Eye Problems in Shih Tzus
Shih Tzus develop eye problems more often than most breeds because their large, protruding eyes sit further outside the skull and get less protection from the surrounding bone structure.
Common issues include corneal ulcers, dry eye, cataracts, and chronic tear staining from excess tear production. Corneal ulcers in particular can worsen within hours, so a vet exam is warranted as soon as redness, cloudiness, discharge, or pawing at the eye appears (Forbes Advisor, 2026). Left untreated, eye irritation can progress to cataracts and, in severe cases, permanent vision loss.
Daily face cleaning and trimming the hair around the eyes reduce irritation. Any change in eye appearance that lasts more than a day is worth a same-week vet visit rather than a wait-and-see approach.
Dental Disease in Shih Tzus
Dental disease is one of the three most common health conditions diagnosed in Shih Tzus, and it tends to be more severe than it looks during a routine awake exam.
The breed's small jaw crowds its teeth, which traps plaque and speeds up periodontal disease. A veterinarian writing for Forbes Advisor (2026) noted that dental X-rays under anesthesia routinely reveal bone loss and root disease that a visual exam misses entirely, meaning a Shih Tzu's mouth can look only mildly affected while significant disease sits under the gumline.
Annual professional cleanings, daily brushing when possible, and dental-specific chews all help slow plaque buildup. The American Animal Hospital Association recommends dental assessments become part of every wellness visit, since untreated periodontal disease causes chronic pain even when a dog shows no obvious symptoms.
Ear Infections
Ear infections are one of the most common recurring problems in Shih Tzus because their floppy ears and long hair trap warmth and moisture, creating conditions where bacteria and yeast multiply.
Ear disorders were the third most common individual diagnosis in a recent Shih Tzu study, affecting close to 6% of dogs (Forbes Advisor, 2026). Signs include head shaking, scratching at the ears, redness, swelling, and a noticeable odor.
Regular ear cleaning with a vet-approved solution, plus keeping the hair around the ear canal trimmed, cuts down on repeat infections. Chronic or recurring infections can point to an underlying allergy, so a dog with frequent ear trouble may need an allergy workup rather than another round of ear drops alone.
Orthopedic Issues: Patellar Luxation and IVDD
Shih Tzus face two main orthopedic risks: a kneecap that slips out of place (patellar luxation) and a spine prone to disc degeneration (IVDD).
Patellar luxation is graded on a four-point scale, with higher grades typically requiring surgical correction and lower grades often managed with conservative care and monitoring (Dogster, 2026). Watch for a dog that skips or hops on a back leg, or briefly holds one leg up while running.
IVDD is a bigger concern for this breed. Shih Tzus are chondrodystrophic, meaning a genetic variant gives them their short legs and long back while also causing their spinal discs to calcify and stiffen earlier than in other breeds. Studies estimate an IVDD lifetime prevalence of roughly 3.5-5% in Shih Tzus, compared with under 0.5% in non-chondrodystrophic breeds, putting the breed's risk at 10 to 12 times higher (Ello Pet Health, 2026).
Signs of IVDD include reluctance to jump, a hunched back, crying out when touched, and, in severe cases, hind-leg weakness or paralysis. IVDD is a same-day emergency once paralysis appears, since surgical decompression within 24 hours gives the best odds of recovery. Ramps for furniture and steady weight control both lower the risk of a disc injury.
Skin Allergies and Coat Issues
Skin disorders are the single most common health problem diagnosed in Shih Tzus, ahead of both dental and eye disease.
Cutaneous conditions affected 16.6% of Shih Tzus in a UK primary-care study, the highest of any category tracked (O'Neill et al., 2024). Atopic dermatitis, an allergic skin reaction to environmental triggers like pollen or dust mites, is one of the most frequently diagnosed skin conditions in the breed. Hot spots and matting-related irritation are also common when the coat is not brushed regularly.
Daily brushing prevents the matting that traps moisture against the skin. A dog that is chewing at its paws, has red or flaky skin, or develops recurring hot spots benefits from an allergy evaluation rather than repeated topical treatment alone.
Urinary Stones
Shih Tzus are prone to calcium oxalate bladder stones, a type of urinary stone that forms from mineral deposits and generally does not dissolve with a diet change alone.
Unlike struvite stones, calcium oxalate stones often require surgical or minimally invasive removal (Forbes Advisor, 2026). Male Shih Tzus carry extra risk because a stone can obstruct the urethra, which becomes a medical emergency. Straining to urinate, blood in the urine, or frequent small urinations are all reasons to see a vet promptly.
Other Conditions to Watch: Anal Sac Impaction and Umbilical Hernias
Shih Tzus show a higher rate of anal sac impaction and umbilical hernias than dogs overall, according to UK veterinary records (O'Neill et al., 2024).
Anal sac impaction causes scooting, licking at the rear, and a strong odor, and it typically responds well to manual expression by a vet or groomer. Umbilical hernias are usually visible from puppyhood as a small soft bulge near the belly button and are often repaired during spay or neuter surgery if they do not close on their own.
Common Mistakes to Avoid with Shih Tzu Health
- Skipping the vet exam because the mouth "looks fine": Dental disease in Shih Tzus is frequently underestimated during an awake exam. A vet-recommended X-ray schedule catches problems a visual check misses.
- Waiting to see if an eye issue clears up on its own: Corneal ulcers can worsen within hours. Same-week vet care is the safer default for any eye change.
- Letting weight creep up: Extra weight worsens both BOAS symptoms and spinal stress, which directly raises IVDD risk.
- Skipping ramps and stairs for furniture access: Repeated jumping on and off furniture adds cumulative stress to a Shih Tzu's spine.
- Treating ear infections without checking for an underlying allergy: Recurring ear infections are often a symptom of atopic dermatitis, not a standalone problem.
Frequently Asked Questions About Shih Tzu Health Issues
What health problems are Shih Tzus most prone to?
Shih Tzus are most commonly diagnosed with skin disorders, dental disease, and eye problems, based on UK primary-care veterinary records (O'Neill et al., 2024). Breathing issues from BOAS and spinal disease (IVDD) are also significant concerns tied to the breed's body shape.
How long do Shih Tzus typically live?
UK data puts Shih Tzu life expectancy at around 11.05 years, with a median age at death of 12.7 years, figures close to the average for dogs overall (O'Neill et al., 2024).
Is IVDD common in Shih Tzus?
Yes. Shih Tzus have an estimated lifetime IVDD risk of 3.5-5%, roughly 10 to 12 times higher than non-chondrodystrophic breeds, because of the same genetic trait that gives them a short-legged, long-backed build (Ello Pet Health, 2026).
How do I know if my Shih Tzu has a breathing problem?
Watch for snoring, snorting, noisy breathing at rest, and difficulty recovering after light exercise. These are signs of BOAS and warrant a veterinary evaluation, since the condition is progressive and often under-recognized by owners.
What is the best way to prevent dental disease in a Shih Tzu?
Daily brushing, dental-specific chews, and annual professional cleanings under anesthesia are the most effective combination. Because visible plaque underestimates the disease under the gumline, X-rays during cleanings catch problems a routine exam cannot.
Do all Shih Tzus need airway surgery?
No. Not every Shih Tzu develops clinically significant BOAS, and severity varies widely. Dogs with mild signs are often managed through weight control and activity limits, while dogs with moderate to severe airway obstruction may need surgical correction.
Key Takeaways
- Skin disorders, dental disease, and eye problems are the three most common health issues in Shih Tzus.
- BOAS and IVDD are both linked directly to the breed's body shape and deserve proactive management, not just reaction after symptoms appear.
- Routine dental X-rays, prompt eye care, and weight control are the highest-impact prevention steps an owner can take.
- Most Shih Tzu health problems are manageable with early detection and consistent veterinary care.
Leave a comment