Shih Tzus are prone to a distinctive set of health problems tied largely to their flat face, small jaw, and compact body. With a lifespan of 10 to 18 years, most owners will encounter at least one or two of these issues over the dog’s life. Here’s what to watch for and what each problem actually looks like in practice.
Breathing Problems From a Flat Face
Shih Tzus are a brachycephalic breed, meaning their skulls are shortened from front to back. That compressed anatomy creates multiple points where airflow can get blocked. The most common findings include abnormally narrow nostrils that may collapse further when the dog inhales, a soft palate that’s too long and partially blocks the airway opening, and tissue near the vocal cords that gets sucked inward during breathing. Some Shih Tzus also have a windpipe that’s proportionally too narrow for their body.
You’ll notice this as noisy breathing, snoring, snorting, and exercise intolerance, especially in hot or humid weather. Overweight dogs tend to have worse symptoms. Mild cases can be managed by keeping your dog at a healthy weight and avoiding heat, but dogs that struggle to breathe during normal activity or regularly gag while eating may need surgical correction to widen the nostrils or shorten the soft palate.
Eye Injuries and Dry Eye
Those large, prominent eyes are one of the breed’s most recognizable features, and also one of its biggest vulnerabilities. Because the eye sockets are shallow, Shih Tzus face a real risk of proptosis, where the eyeball gets displaced forward out of its socket after blunt trauma like a dog fight, a fall, or even rough play. When this happens, the eyelids trap behind the globe and can’t push it back, while swelling makes things worse. The exposed cornea dries out and begins to ulcerate quickly. This is a genuine emergency that requires immediate veterinary care.
A less dramatic but more common eye problem is keratoconjunctivitis sicca, or dry eye, where the tear glands don’t produce enough moisture. You’ll see thick discharge, redness, squinting, and a dull-looking cornea. Left untreated, it leads to painful ulcers and scarring that can impair vision. Treatment typically involves daily eye drops that stimulate tear production, and most dogs need these long term.
Dental Disease and Overcrowding
Shih Tzus pack a full set of adult teeth into a jaw that’s significantly smaller than average, and the results are predictable. Teeth crowd together, overlap, and create hidden pockets where bacteria thrive. Toy and flat-faced breeds have much higher rates of dental disease than larger dogs, and the problems often start by two to three years of age.
Retained baby teeth make things worse. In small breeds, baby teeth frequently don’t fall out on their own by six to seven months of age. The adult teeth erupt alongside them, pushing permanent teeth into abnormal positions and creating even more crowding. Retained baby teeth should be removed promptly to prevent bite problems and long-term complications.
Even a small amount of tartar buildup can lead to significant gum disease and bone loss in these small mouths. Regular dental cleanings and daily tooth brushing at home are more important for Shih Tzus than for most breeds. Without professional care, periodontal disease progresses quickly and can lead to tooth loss, jaw fractures, and infections that spread to other organs.
Chronic Ear Infections
Shih Tzus have heavy, floppy ears covered in long hair, and they also grow hair inside the ear canal itself. That combination reduces airflow and traps moisture, wax, and debris, creating ideal conditions for bacterial and yeast infections. You’ll notice your dog shaking their head, scratching at their ears, or producing a dark, smelly discharge.
Prevention comes down to keeping the ears clean and dry. In some dogs, excess hair inside the ear canal needs to be gently removed to improve airflow. This is best done by a groomer or vet, since pulling too aggressively can damage the delicate canal lining and actually increase infection risk. Regular ear cleaning with a veterinary-approved solution, especially after baths or swimming, helps keep problems from becoming chronic.
Skin Allergies
Atopic dermatitis, an allergic skin condition triggered by environmental substances, is common in the breed. Typical triggers include pollen, mold spores, dust mites, and dander. Affected dogs usually start showing signs between 6 months and 3 years of age, with itching concentrated around the face, paws, ears, and belly.
The itching often leads to scratching, licking, and chewing that damages the skin and opens the door to secondary infections. Shih Tzus with skin allergies may need a combination of approaches: medicated baths, allergy testing, dietary adjustments, and medications that control the immune response driving the itch. The condition is manageable but rarely curable, so expect ongoing maintenance rather than a one-time fix.
Kneecap Dislocation
Patellar luxation, where the kneecap slides out of its normal groove, is one of the most common orthopedic problems in small breeds. You might see your Shih Tzu suddenly skip a step or hold one hind leg up for a few strides before walking normally again. Veterinarians grade the condition on a scale of 1 to 4 based on how easily the kneecap dislocates and whether it stays out of place.
Grade 1 cases, where the kneecap can be manually pushed out of position but pops right back, generally just need monitoring. Surgery is typically considered for grade 2 and above, particularly if the dog is showing lameness or pain. Without treatment, repeated dislocation wears down cartilage over time and can lead to arthritis.
Kidney Dysplasia in Puppies
Renal dysplasia is an inherited condition where the kidneys don’t develop normally. It follows an autosomal dominant inheritance pattern with incomplete penetrance, meaning a dog can carry the gene without being severely affected. In serious cases, puppies may fail to thrive shortly after birth or live only three to six months before developing kidney failure. Signs include excessive thirst, frequent urination, stunted growth, and anemia.
There is no DNA test currently available for this condition. Diagnosis requires a kidney tissue biopsy, specifically a wedge biopsy of the outer kidney, since needle biopsies don’t capture enough tissue to be reliable. Responsible breeders use biopsy screening to reduce the incidence in their lines, though this approach can limit severe cases without fully eliminating the gene from the breeding population.
Umbilical Hernias
Shih Tzu puppies are relatively prone to umbilical hernias, a soft bulge at the belly button where the abdominal wall didn’t fully close after birth. Many small hernias close on their own as the puppy grows. If the hernia is still present at the time of spaying or neutering, surgical repair is typically done during that same procedure.
Most umbilical hernias are harmless, but in rare cases a loop of intestine can slip through the opening and become strangulated, cutting off blood supply to that tissue. A hernia that suddenly becomes hard, painful, or warm to the touch needs emergency surgery.
Housetraining Challenges
Shih Tzus have a reputation for being stubborn about housetraining, and while the breed isn’t inherently harder to train, several factors work against quick success. Their small bladders mean puppies need frequent trips outside. A general rule: puppies can hold it roughly one hour for every month of age, topping out around eight hours for adults. A three-month-old puppy needs a bathroom break every three hours, including overnight.
Common roadblocks include territorial marking (both males and females do this), unclear signals from the dog when it needs to go out, and a subtle training trap where outdoor-loving Shih Tzus learn to dawdle outside because they’ve figured out that finishing their business means going right back in. Consistency matters more than intensity. Rewarding the dog immediately after it eliminates in the right spot, keeping a predictable schedule, and avoiding punishing accidents after the fact are the foundations of success. Intact dogs are more likely to mark indoors, so spaying or neutering can help reduce that behavior.