Shih Tzu Health Problems | Common Health Issues in Shih Tzus

Who could deny such a sweet expression, affectionate personality, and sweet mischievousness—it is no wonder why the Shih Tzu has managed to prance its way from royal Chinese heritage right into the hearts of many. Playfully spirited and ever-charming, these dogs love to be spoiled and pampered. Often sporting their lion-like mane swept up into a ponytail and luxurious coats, these little canines are just as much fun to coddle, cuddle, and cutify as they are to keep with you as an everyday companion.

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 Shih Tzu Health Problems

History and Background of the Shih Tzu Breed 

While the prized Shih Tzu may be seated proudly in mostly American homes these days, these little canines have a regal past in Chinese history. Shih Tzu literally translates to "Lion Dog" in the Tibetan language. Imperial breeders, which often lived in the grand palaces of the emperors of China, created the breed likey by crossing Pekinghese and Lhaso Apso breeds. 

In China, the adored Shih Tzu was so highly regarded that it was reserved only for royalty, and it wasn't even a known breed for everyone else in the world until the latter 1930s. Shih Tzus made it into the AKC registry in 1969 after a bit of breed refining from Peking and England a few decades earlier. 

  • Lifespan: Between 10 and 18 years
  • Height: From 9 to 10.5 inches 
  • Weight: Between 9 and 16 pounds 
  • Group: Toy Group
  • Temperament: Social, playful, charming

Most common Shih Tzu Health Problems 

As it is with a lot of toy breeds, Shih Tzus can have a few more health concerns than most. Here is a look at a few of the most common Shih Tzu health problems. 

1. Entropion

Entropion is just one of the many eye health issues that can affect Shih Tzus, but it is one that is considered hereditary in nature. Entropion involves the abnormal growth of the eyelid; the dog's eyelashes may actually turn inward toward the eye and cause irritation. The condition can affect either the upper or lower eyelid. 


  • Red, irritated eyes
  • Pawing at the eyes 
  • Changes in vision 


It is important that Shih Tzus with entropion receive the proper diagnosis and treatment. Left untreated, corneal ulcers can develop on the eye, which can cause vision impairment or even blindness. Corneal ulcers can lead to enucleation (eyeball removal). Surgical treatment of entropion will cost anywhere from $300 to $1500. 

Tips for Owners

  • Make sure you are working with a reputable breeder who follows CERF testing 
  • Don't delay if you suspect the dog has entropion; the outcome with no treatment can mean permanent blindness 

2. Patellar Luxation

Shih Tzus are one of the smaller canines that are at a high risk of patellar luxation, which is a dislocation of the knee cap. The knee cap may shift out of place occasionally and go back in place or it may move and not go back in place at all. Patellar luxation is considered to be a joint structure issue that is passed from the parents of the dog. 


  • Knee caps can be displaced easily 
  • Knee caps slip out of place while the dog is walking 
  • Awkward gait 
  • Inactivity 


While patellar luxation can be mild and barely affect the dog at all, some Shih Tzus will require treatment. If the kneecap stays out of place, it can lead to discomfort and inflammation. Surgery to permanently tack the knee cap in place is done in more severe cases, which can cost $1,500 to $3,000 per knee. Medication to help with pain and inflammation in milder cases will cost only $20-$50 per month. 

3. Arachnoid Cysts

Shih Tzus may develop arachnoid cysts, which are cysts in the membrane of the central nervous system. This occurs when the membrane does not develop as it should, which seems to stem from a genetic predisposition. Pugs and Shih Tzus are two of the few dogs that can be affected. The cysts that develop are small, fluid-filled lesions. most dogs do not show symptoms at all unless the cysts develop around the spinal column. 


  • Wobbly gait 
  • Exaggerated gait 
  • Not placing limbs properly while walking 
  • Loss of vision
  • Seizures
  • Limb weakness


The diagnosis of arachnoid cysts can be relatively difficult and expensive. Typically, an MRI will be required to find the lesions in the dog's body, and the lesions are easily missed. CT scans and the use of contrast dye may also be necessary, especially if cysts are suspected around the spinal column. If surgery to remove the cysts is performed, especially in spinal areas, the dog's condition may be as much as 100 percent improved. However, not all cysts are operable. Altogether, diagnosis and treatment can be between $4,500 and $10,000.

4. Fold Dermatitis

Fold dermatitis is a skin condition that affects the folds in the skin, and it is especially problematic for canines that have pronounced skin folds. The extra weight of the skin around these folds can lead to an overgrowth of bacteria and a greater risk of both inflammation and infection. The natural form of the Shih Tzu's snout and face can mean more pronounced wrinkles and more of a risk of fold dermatitis. 


  • Red, irritated skin between skin folds
  • Pawing at the folds in the skin 
  • Excessive itching
  • Foul odors radiating from skin folds 
  • Obvious signs of yeast in skin folds 
  • Abrasions in skin folds 


The most important thing Shih Tzu owners can do to prevent problems with fold dermatitis is to keep the folds in the skin as clean as possible. The vet can offer bactericidal wipes that can be used for everyday cleaning. Treatment after dermatitis has formed can involve topical agents, oral antibiotics, or other methods. The cost of treatment can be as little as $300 or as high as $2,500 in the most severe cases. 

Tips for Owners 

  • Be sure to wash skin folds during bathing 
  • Trim hair around folds to help with keeping the area clean 
  • Always visit a vet as soon as you suspect a skin infection

5. Distichiasis and Ectopic Cilia

Distichiasis and ectopic cilia are eye conditions that Shih Tzus can be at risk of inheriting from their parents. Distichia involves abnormal growth of eyelashes at the outer edge and ectopic cilia involves abnormal eyelash growth on the interior parts of the eye. Distichia is not always symptomatic; some dogs will have no issues at all. However, most dogs with ectopic cilia will have extreme discomfort. In either condition, both eyes are most often affected. 


  • Excessive tearing 
  • repetitive blinking 
  • Conjunctival infections 
  • Red, irritated eyes
  • Pawing at the eyes 


Most dogs will not require treatment for distichiasis, but it is common for ectopic cilia to require prompt surgical attention. During a procedure referred to as cryoepilation, the hair follicles that are causing issues are actually frozen with a small probe so growth will stop and the problematic hairs are removed. For Shih Tzus over three, surgery can be as much as 90 percent effective, but younger dogs may have the problem return as hair follicles reform. The cost of surgery can be between $1,500 to $2,000. 

6. Dental Problems 

A lot of toy group breeds do have risks of dental issues, which is related to the fact that the mouth is smaller and teeth can be a bit crowded. Shih Tzus can be prone to dental issues like periodontal disease, decay, or broken teeth. 


  • Avoiding food 
  • Bad breath 
  • Loose teeth or losing teeth 
  • Bleeding gums 


All Shih Tzus should have dental visits with a veterinary dentist every few years and teeth should be assessed by the vet at every wellness exam. Treatments can vary depending on the dental problem at hand. For example, decayed teeth will likely have to be extracted to thwart the risks or oral infection. Dental x-rays and anesthesia for extraction is typically between $200 and $400, and you will pay a bit more for the actual extraction. 

7. Brachycephalic Syndrome

Also referred to as respiratory distress syndrome, the brachycephalic syndrome affects dogs that have a shorter snout like the Shih Tzu. This syndrome can mean issues with smaller nostrils, a narrow trachea or windpipe, and general airway obstructions.


  • Coughing 
  • Gaspin
  • Wheezing or snoring 
  • Fainting 
  • Bluish gums


Surgery is an option in most cases but is usually only performed when the condition is so severe that it affects the dog's quality of life. Costs of surgery can be anywhere from $200 to $1,500 or more depending on what part of the snout or airway needs to be corrected. In situations when the condition is not severe, Shih Tzu owners must properly monitor their pet, make sure they stay cool, and keep a close eye on them during activity or eating and drinking. 

Black and White Shih Tzu

Other Shih Tzu Health Problems 

Hip Dysplasia - Hip dysplasia is common among a lot of larger breeds, but some smaller canines are just as much at risk, including the Shih Tzu. Hip dysplasia is a malformation of the hip joint that can make it easy for the hip to slip out of place. The condition is hereditary, but there are ways owners can reduce risks, such as keeping the dog's weight in check and making sure their growing puppy gets a healthy food from the beginning. Treatment many involve oral medications or surgery depending on the severity of the condition. 

Harderian Gland Prolapse - Hrderian gland prolapse is a prolapse of a tear-producing gland in the eye. The gland will not be properly connected, which means it may move around, lead to swelling of the eye and eyelid, and even lead to bloody discharge. Problems with harderian gland prolapse will typically happen to a Shih Tzu before the age of two, and treatment involves a simple surgery that is considered highly successful. 

Renal Dysplasia - If a Shih Tzu's kidneys do not mature to the sie they should, it is a condition known as renal dysplasia. the condition is considered genetic, but even puppies from tested parents can develop kidney problems. Puppies with renal dysplasia do not thrive well and may have a shorter life span. 

Cancer - Many of the dogs in the toy group are prone to cancer, but it is more relative to the fact that they have longer life spans than a lot of older dogs. Cancer is actually a primary cause of death for older canines. When caught early, canine cancer is treatable. Watch out for odd or new lumps and bumps on your Shih Tzu, which can be a sign of cancer.

Intervertebral Disc Disease (IVDD) - IVDD, which is sometimes also referred to as IVD, is common among breeds with a long spinal column and shorter legs, such as the Shih Tzu. The condition is characterized by disk slippage in the spine, which puts undue stress on the spinal cord and can generate issues with limb weakness, muscle spasms, and pain. IVDD can occur in dogs as young as two, and the condition can be either mild or severe. Mild cases may require medication for comforting the dog and severe cases could potentially lead to paralysis. 

Heart Disease - Shih Tzus can be at a higher risk of certain types of heart disease, and these conditions can occur pretty much at any age. Abnormal heart rhythm or heart murmur are perhaps the most common heart issues fo the breed, both of which are typically treated with oral medications. Valve deterioration can also be an issue. 

Hyperadrenocorticism (Cushing's Disease) - Cushing's Disease causes the adrenal glands to produce too many steroidal hormones in the dog's system. Increased thirst and urination, changes in appetite, ad thin skin or hair loss are all symptoms to watch for. Treatment involves medications to regulate hormone levels. 

The Shih Tzu: The Long-Living Perfectly Spoilable Lap Dog 

Shih Tzus rarely ever meet a stranger, and they don't ask for much other than a lot of love and affection. While these toy dogs may have a long list of health concerns, you could ask any owner and they would tell you they would still prefer their little lion dog over many other breeds. With a good breeder and a reputable vet for wellness checks, your adorable pal is bound to be a mainstay in your life for years to come.



Author Sheena HarrisAuthor: Sheena Harris
About Sheena: 
Sheena Harris has 10 years of experience in canine health wellness. Having worked with both veterinarians and breeders across the country to curate content, she has a wealth of insight to share on pet wellness, proper breeding practices, and keeping canine companions happy. Her history in breeding AKC-registered beagles lends a great deal of firsthand insight to her work. She's also been published at  


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