After years of seeing Shih Tzus in the exam room, I can tell you they are wonderful companions, but they come with a fairly predictable list of health quirks. Most trace back to two things: a flat face and a small body. That short skull affects their breathing and their eyes, while their compact frame predisposes them to dental crowding and joint issues. The good news is that none of this is mysterious, and a well-informed owner can prevent or manage the large majority of it.
My goal here is not to alarm you but to give you a clear early-warning system. When you know which signs to take seriously, you stop minor issues from becoming costly emergencies. Below I walk through what these conditions actually are, the symptoms I want you watching for, what causes them, and how treatment and prevention work in real life.
What Are Common Shih Tzu Health Problems?
Shih Tzu health concerns cluster into a few categories driven by their anatomy. Understanding the categories makes the individual conditions much easier to remember.
Most Shih Tzu health problems fall into four groups: airway issues from the flat face (brachycephalic syndrome), eye problems from their large prominent eyes, dental disease from a crowded small jaw, and orthopedic issues such as a slipping kneecap (luxating patella) or back disc problems. Knowing these four buckets helps you spot trouble early and ask your vet the right questions.
This breed is brachycephalic, the medical term for a shortened skull. That single trait explains the snoring, the heat sensitivity, and the bulging eyes. Their small jaw explains the dental crowding, and their build explains the kneecap and spine concerns. Skin fold irritation around the face and ear infections under those long ears round out the common list.
Symptoms to Watch For
These are the signs that should prompt a closer look or a call to your vet. Many Shih Tzu problems give you early warning if you know what to watch.
Blue or grey gums, collapse, frantic gasping, or a dog that cannot settle and breathe are emergencies. Brachycephalic dogs can overheat and decompensate quickly. Get to an emergency vet immediately. Do not wait to see if it passes.
What Causes It
Most of these conditions come from the breed’s structure rather than anything an owner did wrong. Here is how the causes break down by group.
Airway and breathing
- Short skull (brachycephalic anatomy)
- Narrowed nostrils
- Elongated soft palate
- Heat and humidity stress
Eyes
- Large, forward-set eyes
- Shallow eye sockets
- Facial hair contacting the eye
- Reduced tear protection
Mouth and teeth
- Small, crowded jaw
- Plaque and tartar buildup
- Retained baby teeth
- Lack of routine brushing
Joints and spine
- Luxating patella (slipping kneecap)
- Intervertebral disc strain
- Excess body weight
- Jumping from heights
Carrying extra weight worsens breathing, strains the kneecaps and back, and increases anesthetic risk if dental or other surgery is ever needed. Keeping your Shih Tzu lean is one of the single most protective things you can do across nearly every condition on this list.
Treatment and Recovery
Treatment depends entirely on the problem, but the path usually starts the same way: a proper veterinary diagnosis rather than guesswork. Here is how care typically unfolds.
Get an accurate diagnosis
Your vet examines the airway, eyes, mouth, joints, and skin, and may use imaging or eye stains to pinpoint the issue. Naming the problem correctly is the foundation of effective treatment.
Address pain and infection first
Eye injuries, dental infections, and ear infections often need prompt medication. Pain control and antibiotics where appropriate make your dog comfortable and stop the problem spreading.
Consider procedures when needed
Some conditions, such as severe airway narrowing, advanced dental disease, or a high-grade luxating patella, may require surgery. Your vet will weigh the benefits against your individual dog.
Manage at home
This includes weight control, eye and fold cleaning, ear care, and tooth brushing. Day-to-day management often matters as much as any single treatment.
Recheck and adjust
Many of these are lifelong management situations. Regular rechecks let your vet catch progression early and fine-tune the plan as your dog ages.
Prevention and Home Care
You cannot change your Shih Tzu’s anatomy, but consistent home care prevents a surprising amount of suffering and cost. These are the habits I recommend to every Shih Tzu owner.
- Brush teeth daily with pet-safe toothpaste
- Keep your dog lean and measure all meals
- Trim facial hair away from the eyes and clean folds
- Avoid heat and never leave your dog in a warm car
- Use a harness instead of a neck collar to protect the airway
- Discourage jumping from sofas and beds to protect knees and spine
- Check and dry the ears regularly
- Schedule routine vet exams, twice yearly for seniors
Small dogs are affected by even small amounts of toxic foods and household products. Keep grapes, raisins, onions, garlic, chocolate, and xylitol away from your Shih Tzu. If you suspect a poisoning, contact your vet or the ASPCA Animal Poison Control Center at 888-426-4435.
Safety note: Brachycephalic breeds like the Shih Tzu can overheat and develop breathing emergencies fast, so avoid heat and exertion and seek immediate veterinary care for any blue gums, collapse, or severe breathing struggle.
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What you need to know
The flat face that gives the Shih Tzu its sweet look also brings the breed’s biggest worries. Brachycephalic airway issues can cause noisy breathing, snoring and trouble cooling down, so keep walks gentle in hot weather and watch for laboured breathing. Their large, shallow-set eyes are prone to dryness, ulcers and injury, so wipe the face daily and ask a vet about any cloudiness or squinting.
This breed is also prone to dental crowding, ear infections under the long coat, and hip or kneecap problems as they age. Keep the skin folds clean and dry to prevent dermatitis, and brush the coat to avoid mats that trap moisture. None of this replaces veterinary care, so book a check if breathing, eyes or skin look off rather than waiting it out.