Shih Tzu Eye Issues

Not every Shih Tzu will experience problems; however, this breed is prone to eye issues that are commonly seen with brachycephalic breeds, due to prominent eyes within shallow eye sockets.

A note on the third eyelid: The third eyelid (nictitating membrane) is involved in some of the eye issues that we will be covering, so it’s a good idea to be reminded what this is. Canines have an upper eyelid, a lower eyelid, and a third eyelid that closes across the eye (rather than up and down). This transparent third lid serves to lubricate the eye and produces 1/3 of a dog’s natural tears. 

Inflammation in dogs' eyes is a broad condition often resulting from irritation. This encompasses various symptoms and potential causes.

Symptoms: Signs include frequent blinking or squinting, aversion to bright light, unusual eye discharge, redness in the eyes, and swelling of the eyelids.

Common Causes: The most typical cause of eye inflammation is foreign particles entering the eye. In rarer instances, certain diseases might also be responsible.

Diagnostic Process: Veterinarians diagnose this condition using specialized instruments to thoroughly examine the interior structure of the eye. Blood tests may be conducted if the initial examination doesn't reveal the cause.

Treatment Approach: Immediate home treatment can involve using a canine-specific eye rinse to flush out irritants; see also: Shih Tzu Eye Care for instructions. If symptoms persist or worsen after 3 days, professional veterinary care is recommended.

Treatment usually involves anti-inflammatory drugs to reduce swelling, antibiotics for infections or to preempt them, and pain-relieving eye drops. In cases where a disease is identified as the root cause, the treatment plan will be tailored to that specific health issue.

Prognosis: The outlook is generally positive for inflammation stemming from acute, non-disease-related causes. However, if a chronic underlying disease is identified, the prognosis will depend on the nature and severity of that condition.

Dry eye, medically known as keratoconjunctivitis sicca, is a painful condition characterized by the development of an abrasion in the tear film that naturally coats the eye. It primarily occurs in middle-aged and senior dogs, and certain breeds like Shih Tzus are predisposed to it.

Symptoms: Common signs of dry eye include frequent blinking, severely red eyes (possibly obscuring the sclera, or white part of the eye), thick yellow discharge or pus, visible third eyelid, inflammation around the eyelids, and vision problems. Severe, untreated cases can lead to scarring and potentially total vision loss.

Common Causes: Besides a genetic predisposition in certain breeds, like the Shih Tzu, other causes may include adverse reactions to medications, canine distemper, and some neurogenic diseases.

Diagnostic Process: Diagnosis involves a Schirmer tear test to measure tear production, with low levels indicating dry eye. Fluorescein staining under a Wood’s light helps detect abrasions or ulcerations. Additional tests may be conducted to identify bacterial infections.

Treatment Approach: Treatment, which must be overseen by a veterinarian, typically includes artificial tears, lubricating eye drops, pain and inflammation medication, and sometimes antibiotics.

Surgery might be required in rare instances of tear duct damage. Follow-up Schirmer tear tests are conducted after 4 and 6 weeks to monitor progress. Some dogs may require lifelong treatment with artificial tears.

Prognosis: The prognosis is very good when dry eye is diagnosed and treated early. However, delayed treatment leading to scarring can result in partial or complete loss of vision.

Overview: Cherry eye is a condition where a dog's third eyelid, also known as the nictitating membrane, becomes displaced and noticeably bulges out. Prompt treatment is crucial to prevent swelling and subsequent complications.

Symptoms: The primary sign of cherry eye is a visible pink or red protrusion over the sclera (the white part of the eye). This may be accompanied by excessive blinking or squinting, bloodshot eyes, discharge, swelling around the eye, and potential vision impairment.

Common Causes: The condition is believed to arise from a weakening of the connective tissues. While it rarely affects both eyes simultaneously, the occurrence in one eye often leads to a similar issue in the other eye within a few months.

Diagnostic Process: Diagnosis of cherry eye is typically straightforward, as the protruding gland is easily visible to a veterinarian.

Treatment Approach: Treatment requires veterinary intervention and usually involves a simple surgical procedure. While awaiting surgery, topical antibiotics and anti-inflammatory medications may be prescribed. During the operation, a portion of the nictitating membrane is removed, and the remaining tissue is sutured back into place.

Owing to the high likelihood of the condition developing in the other eye, veterinarians often recommend preemptively securing the nictitating membrane of the unaffected eye.

Prognosis: The prognosis for dogs with cherry eye is very good, with most eyes returning to a normal appearance following treatment. Early intervention and proper surgical care are key to successful recovery.

Overview: Entropion is a genetic condition where one or both eyelids (upper or lower) roll inward, typically developing within the first year of a dog's life. The primary concern is the inward-pointing eyelashes that can scratch the eye's surface, potentially leading to corneal ulcers. Secondary complications include scar tissue formation, which can impair vision or even cause vision loss.

Symptoms: Symptoms can vary based on the dog's breed size. In toy breeds like the Shih Tzu, the most common signs are excessive tearing and inflammation around the affected eye(s).

Common Causes: Entropion is prevalent in brachycephalic breeds due to increased tension in the inner eye ligaments. It is also more common in toy and giant breed sizes. Other contributing factors can include repeated eye infections or significant weight loss.

Diagnostic Process: Diagnosis is usually straightforward, as the inverted eyelid is clearly visible to a veterinarian.

Treatment Approach: Treatment requires veterinary intervention. In mild cases without corneal ulceration, temporary stitching of the eyelid may be sufficient, along with artificial-tear medication. However, most cases necessitate surgical correction. As the surgery is being scheduled, the vet may prescribe topical antibiotics, anti-inflammatory medication, and lubricating eye drops. The surgical procedure involves repositioning and suturing the eyelid into its proper place.

Prognosis: The prognosis for dogs undergoing treatment for entropion is very good, with a success rate of 90-95%. Early detection and appropriate surgical intervention are crucial for a positive outcome.

Cuteness break!

Max, photo courtesy of Jim F. 

Overview: Distichiasis and ectopic cilia are conditions frequently seen in the Shih Tzu breed, involving abnormal growth of eyelashes. In distichiasis, one or more lashes grow in unusual places on the eyelid. Ectopic cilia, however, involve lashes growing through the inside of the eyelid, directed inward towards the eye. These conditions can be painful and may lead to corneal ulcers.

Symptoms of Distichiasis: Dogs with distichiasis may exhibit eye pain, abnormal eyelid twitching, excessive tearing, redness in the eyes, and changes in iris pigmentation.

Symptoms of Ectopic Cilia: Ectopic cilia typically present with eye pain, abnormal eyelid twitching, and excessive tearing.

Diagnostic Process: The diagnosis for both conditions is usually straightforward, as the aberrant eyelashes are visible to a veterinarian.

Treatment Approach: Treatment, overseen by a veterinarian, varies based on severity. In some cases, the problematic eyelash(es) can be plucked out. However, it's important to note that they often grow back within 4 to 5 weeks, necessitating repeated removal.

A minor surgical procedure can be performed to remove both the eyelash and its follicle, preventing recurrence. Any associated corneal ulcers will also be treated as part of the management plan.

Prognosis: With timely and appropriate treatment, the prognosis for dogs with distichiasis and ectopic cilia is generally positive. Regular veterinary check-ups and prompt attention to recurrence are important for long-term management and comfort.

The cornea, a clear and shiny membrane on the eyeball's surface, consists of four layers: the epithelium, basement membrane, stroma, and Descemet’s membrane. Injuries to these layers can range from mild abrasions to severe ulcerations and descemetocele.

Types of Corneal Injuries:

• Corneal Abrasion: A superficial scrape affecting only the epithelium (1st layer).
• Corneal Ulcer: A deeper injury extending through the epithelium into the basement membrane (2nd layer) or stroma (3rd layer).
• Descemetocele: A severe injury penetrating through the first three layers and reaching Descemet’s membrane. Rupture of this layer can lead to the collapse of the eye due to the leakage of internal fluids.

Symptoms: Common signs include pawing at the eye due to pain, rubbing the eye against surfaces, sensitivity to light, keeping the eye closed, and discharge in some cases.

Causes: Trauma is the most frequent cause. Other causes include entropion, chemical burns from harsh shampoos, eye infections, dry eye (keratoconjunctivitis sicca), diabetes, and hypothyroidism.

Diagnostic Process: Mild corneal abrasions may not be visible without special equipment. A veterinarian will use a fluorescein stain and a Wood’s light to identify ulcerations after numbing the eye.

Treatment Approach: The treatment varies depending on the severity and type of injury and must be determined by a veterinarian.

Corneal Abrasions: Typically heal on their own within a week. Topical antibiotics and a protective collar to prevent further injury may be prescribed.

Corneal Ulcer/Descemetocele: Treatment ranges from temporary eyelid stitching to promote healing, to more extensive surgeries like grafts or transplants for severe cases. If both eyes are affected, they may be treated sequentially. When ulcers do not heal properly, surgical debridement of dead cells and eyelid closure may be necessary.

Note: Misdiagnosis of a minor abrasion when it is actually an ulcer can occur. If there is no improvement after 2-3 days of treatment, a reevaluation by the veterinarian is crucial.

Prognosis: With prompt and appropriate veterinary care, the prognosis for corneal injuries can be positive, though it varies based on the injury's severity and the treatment's effectiveness.

Conjunctivitis, often referred to as "pink eye," is a common eye condition in dogs, characterized by inflammation or infection of the conjunctiva, the pink lining inside the eyelids. It can cause discomfort, ranging from itchiness to pain, and often leads dogs to paw at their eyes or squint.

All dogs are susceptible to conjunctivitis, but breeds like the Shih Tzu with short noses and large eyes, are more prone. Older dogs and those with health conditions may also be more vulnerable due to weakened immune systems.

Types of Conjunctivitis:

• Allergic Conjunctivitis: Caused by environmental allergens like pollen or dust.
• Bacterial Conjunctivitis: Results from bacterial infections, leading to pus-like discharge.
• Viral Conjunctivitis: Triggered by viruses such as the one causing distemper, causing watery discharge.
• Keratoconjunctivitis Sicca (KCS): Also known as dry eye, it occurs when there's insufficient tear production, leading to chronic conjunctivitis.

Symptoms: Common signs include redness in the eyes, excessive tearing or unusual discharge, frequent blinking or squinting, swollen eyelids, rubbing the face, and sensitivity to light.

Causes: Environmental irritants (smoke, dust, pollen), trauma (scratches, foreign objects), birth defects (tear duct problems), and pre-existing conditions like diabetes or hypothyroidism can lead to conjunctivitis.

Diagnostic Process:Involves a thorough eye examination, possibly using special stains for corneal ulcers and tear production tests.

Treatment: Varies based on the underlying cause. Options include medications (antibiotic ointments or drops, medicines to stimulate tear production), regular saline flushes and wearing an e-collar to prevent eye rubbing. Surgery may be recommended for severe cases with physical abnormalities

Contagiousness: While not typically contagious to humans, it can spread to other pets, especially if bacterial or viral. 

Recovery and Management: Monitoring for symptom progression and preventing a Shih Tzu from scratching or rubbing the eyes is crucial for recovery. Most dogs recover well with appropriate care.

Prevention: Clean your Shih Tzu's eye area on a regular basis and avoid letting your little guy or gal poke around under bushes or do other such activities that could damage the eye. 

See also: Grooming a Shih Tzu for details on all grooming tasks, including the eyes.

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