The Shih Tzu's large, round, forward-facing eyes are one of the breed's most endearing features, but their prominent position also makes them unusually vulnerable to injury and disease. Eye problems are among the most common reasons Shih Tzu owners visit the veterinarian.

Corneal ulcers are a frequent and sometimes serious concern. Because the eyes protrude beyond the protective plane of the skull, they are easily scratched by vegetation, rough play, contact with other animals, or even by the dog's own hair if the face is not kept properly groomed. A corneal ulcer causes squinting, tearing, redness, and pawing at the eye. Superficial ulcers typically heal well with antibiotic eye drops and an Elizabethan collar to prevent rubbing. Deeper ulcers, however, can progress rapidly and may require specialized treatment or surgery to prevent perforation of the cornea.

Proptosis (forward displacement of the eyeball from the socket) is a traumatic emergency that occurs more commonly in brachycephalic breeds. Relatively minor trauma to the head can cause the eye to displace forward past the eyelids. This is a true emergency requiring immediate veterinary attention. The eye must be kept moist and replaced as quickly as possible to have the best chance of saving vision.

Keratoconjunctivitis sicca (dry eye) occurs when the tear glands do not produce adequate moisture. Shih Tzus are prone to this condition, which causes thick, mucoid discharge, redness, and a dull, dry-looking corneal surface. Without treatment, chronic dry eye leads to pigmentation, scarring, and eventual blindness. Daily treatment with tear-stimulating drops (cyclosporine or tacrolimus) is highly effective in most cases.

Distichiasis (extra eyelashes growing from abnormal locations) and entropion (inward rolling of the eyelid) can also cause chronic corneal irritation. If your Shih Tzu has persistent tearing, squinting, or reddened eyes, a thorough ophthalmic examination can identify the source and guide appropriate treatment.

Preventive measures include keeping facial hair trimmed away from the eyes, using veterinary-recommended eye wipes to clean discharge, and being cautious during play and outdoor activities to minimize the risk of eye trauma. Regular veterinary eye exams can catch subtle conditions like dry eye or cataracts before they cause significant damage.

The Shih Tzu's flat face places them in the brachycephalic category, though they are generally less severely affected than breeds like English Bulldogs or Pugs. Still, many Shih Tzus have some degree of brachycephalic obstructive airway syndrome (BOAS), which can include stenotic (narrowed) nostrils, an elongated soft palate, and a narrowed trachea.

Snoring, snorting, and noisy breathing are common in the breed. While mild respiratory noise may be tolerated, significant airway compromise manifests as exercise intolerance, open-mouth breathing, gagging after eating or drinking, cyanosis (blue-tinged gums) during exertion, and difficulty breathing in warm or humid conditions.

For Shih Tzus with clinically significant BOAS, surgical correction of stenotic nostrils and/or soft palate resection can improve airflow and quality of life substantially. Many veterinary surgeons recommend evaluating brachycephalic dogs for airway surgery at a young age, potentially at the time of spaying or neutering.

Reverse sneezing is an episode of rapid, noisy inhalation through the nose that can sound alarming but is generally benign. It is very common in brachycephalic breeds and is caused by irritation of the soft palate or nasopharyngeal area. Episodes usually resolve on their own within seconds to a minute. Gently covering your dog's nostrils for a moment or softly rubbing the throat can sometimes help end an episode. If reverse sneezing becomes very frequent or is accompanied by nasal discharge, have your veterinarian investigate to rule out nasal foreign bodies, polyps, or other issues.

Heat sensitivity, while not as extreme as in more severely brachycephalic breeds, is still a concern. Shih Tzus should not be exercised vigorously in hot weather, and access to shade, fresh water, and air conditioning is important during summer months. Their dense coat adds to heat retention, making regular grooming essential for thermal comfort.

Allergic skin disease (atopic dermatitis) is very common in Shih Tzus. Environmental allergens such as dust mites, pollen, mold spores, and grasses trigger an overactive immune response in the skin, causing chronic itching, redness, and recurrent infections. Affected dogs often lick or chew their paws, scratch their ears, and rub their faces. The belly, armpits, and groin are frequently inflamed.

Managing atopic dermatitis is a lifelong commitment. Treatment options include allergen-specific immunotherapy (allergy shots or sublingual drops based on allergy testing results), medications that target the itch pathway (oclacitinib or lokivetmab), medicated baths with soothing shampoos, and fatty acid supplementation to support the skin barrier. Your veterinarian or a veterinary dermatologist can develop a customized management plan.

Ear infections are closely linked to allergies in Shih Tzus. The breed's floppy, densely furred ears create a warm, humid environment in the ear canal that fosters bacterial and yeast overgrowth. Dogs with allergies produce excess ear wax and have inflamed ear canals, further increasing infection risk. Signs of ear infection include head shaking, scratching at the ears, redness or swelling of the ear flap, odor, and discharge.

Regular ear cleaning with a veterinary-recommended ear cleanser helps prevent infection buildup. Your groomer can also thin the hair within the ear canal to improve airflow. Chronic, recurrent ear infections that do not respond to standard treatment may benefit from referral to a veterinary dermatologist to address the underlying allergic disease more aggressively.

The Shih Tzu's long, flowing coat requires regular grooming to prevent matting, which can trap moisture against the skin and lead to skin irritation or bacterial infection (hot spots). Whether you maintain the coat at full length or keep it in a shorter "puppy clip," regular brushing and professional grooming every four to six weeks are essential. Matting around the face, behind the ears, in the armpits, and around the hindquarters is particularly common and can become painful if neglected.

Food allergies, though less common than environmental allergies, should be considered if skin or gastrointestinal symptoms persist despite treatment. A veterinary-supervised elimination diet trial is the gold standard for diagnosing food allergies.

Like most small breeds, Shih Tzus are highly prone to periodontal disease. Their small jaws create crowding, and retained deciduous teeth compound the problem. Without consistent dental care, tartar accumulates rapidly, gum disease progresses, and tooth loss follows. The systemic effects of chronic oral infection can affect the heart, kidneys, and liver.

Commit to daily tooth brushing and plan for regular professional dental cleanings. Dental radiographs are essential in small breeds to evaluate hidden root and bone disease. Early intervention preserves teeth and prevents the pain and complications of advanced periodontal disease.

Patellar luxation is common in Shih Tzus. The kneecap intermittently slides out of position, causing a momentary skip or hop in the gait. Mild cases may not require treatment, but recurrent luxation with progressive lameness benefits from surgical correction. Maintaining a lean body weight reduces stress on the knees.

Intervertebral disc disease (IVDD) can also occur in Shih Tzus, though less frequently than in Dachshunds. The signs are similar: back or neck pain, reluctance to move, weakness or wobbling in the hind legs, and in severe cases, paralysis. Prompt veterinary evaluation is essential for the best outcome.

As Shih Tzus age, kidney disease becomes a consideration. Chronic kidney disease develops gradually, and early detection through routine blood and urine screening allows for dietary and medical interventions that can slow progression and maintain quality of life. Most veterinarians recommend annual senior wellness panels starting around age seven, which include kidney function markers.

Hypothyroidism has been reported in the breed and presents with weight gain, lethargy, and coat changes. A simple blood test diagnoses the condition, and daily thyroid supplementation is effective and affordable.

Shih Tzus are generally a long-lived breed, with most reaching 10 to 16 years. Their cheerful, affectionate nature makes them wonderful companions, and investing in preventive health care helps ensure those years are comfortable and joyful. Regular veterinary visits, consistent grooming, dental care, weight management, and prompt attention to any changes in behavior or health are the foundations of a long, happy life with your Shih Tzu.