Top 5 Preventable Health Issues in Shih Tzus
Overview
Shih Tzus pack a lot of personality into a sturdy little frame, yet their signature anatomy: prominent eyes, a short muzzle, pendulous ears, and compact joints, sets the stage for a handful of predictable health challenges.
The following guide focuses on 5 issues that veterinarians see repeatedly in this breed: corneal injuries, dental disease, osteoarthritis, ear infections, and skin allergies. For each one you will find stats backed by current data, along with clear, practical steps to reduce risk and improve comfort.
Use these recommendations as a working checklist to help your Shih Tzu stay active, pain-free, and well-cared-for throughout every life stage.
Please note: AllShihTzu is reader-supported, and some of the product suggestions on this page are affiliate links. As an Amazon Associate we earn from qualifying purchases. This is at no extra cost to you and helps keep this site running.
#1 Corneal Ulcers & Eye Injuries
Overview: Anatomy = Eye Injuries
Shih Tzus have large, prominent eyes that make them especially prone to scratches and other eye trauma. A corneal injury refers to damage to the clear outer layer of the eye, often caused by debris, blunt impact, or scratches.
If not properly treated, this can progress into a corneal ulcer: a painful open sore that may lead to infection, vision loss, or in severe cases, deeper damage that threatens the eye itself.
Even everyday actions like rubbing their face on rough surfaces, brushing against dense plants, or playful paw swipes can put their eyes at risk.
Signs of Eye Injury:
Signs that there's something wrong with the eyes include squinting or blinking more than usual, increased tearing or discharge, rubbing or pawing at the eye, redness or cloudiness in the cornea, and/or light sensitivity.
Stats:
Approximately 1% of all dogs develop corneal ulcers each year, but brachycephalic breeds like Shih Tzus are over 11 times more likely to develop them than longer‑nosed breeds [1]. In one large study, 3.45% of Shih Tzus examined had corneal ulcers, nearly double the overall average, and among those affected, about 60% required pain relief and 20% underwent surgery [2].
How to Prevent This Health Issue:
Because eye injuries can progress quickly and have lasting effects, you’ll want to focus on prevention and react fast to any problems. A few small habits, done consistently, can dramatically lower your Shih Tzu’s risk of developing eye injury, painful ulcers, or vision issues.
#1 Wipe your Shih Tzu’s eye area daily to clear debris and spot early irritation. A thin, slightly damp cloth can work, but canine eye wipes like Earthbath Hypo-Allergenic Eye Wipes are ideal: they’re gentle, reach crevices, and help prevent tear staining from excess moisture and buildup.
#2 Work to avoid the top causes of scratches which include walking through or under dense shrubbery and low branches and rough play with other animals.
#3 Use canine eye lubricant drops in dry or windy weather to prevent overly dry eyes and protect the cornea. One that we like is I-Drop Vet Plus Eye Drops for Dogs. It provides really fast relief and it's formulated to spread as a dog blinks, so it's comfortable for them.
#4 Schedule regular eye exams, especially as your Shih Tzu gets older or if you notice signs of eye irritation or vision issues.
#5 Act fast on warning signs. At the first hint of squinting, discharge, or eye discomfort, contact your vet. Prompt care can often prevent serious complications.
#2 Dental Disease
Overview: Facial Structure = Dental Issues
Shih Tzus are among the breeds most prone to dental issues due to their brachycephalic (short-muzzled) structure. Their small jaws often lead to crowded or misaligned teeth, creating tight spaces that easily trap food and bacteria. As a result, plaque can harden into tartar in as little as 48 hours.
Unremoved, tarter can lead to gingivitis, periodontal disease, jawbone deterioration, and eventual tooth loss. Left unchecked, oral infections can also impact the heart, liver, and kidneys.
Signs of Dental Disease:
Signs that a Shih Tzu's teeth need more attention include bad breath, yellowing teeth, gum redness, excessive drooling, and/or reluctance to eat.
Stats:
Studies show that over 80% of dogs have some form of dental disease by age 3 [3]. Another revealing study on dental disease by breed size [4] found that extra-small dogs (weighing under 14.3 lbs. or 6.5 kg), a category that includes the Shih Tzu, were diagnosed with periodontal disease at 5 times the rate of larger dogs.
When reviewing the data by dog size, researchers found that extra-small breeds (<6.5 kg/14.3 lbs.) were up to five times more likely to be diagnosed with periodontal disease than giant breeds (>25 kg/55 lbs.).
How to Prevent This Health Issue:
With good dental hygiene being critical for a Shih Tzu’s long-term health, you’ll be relieved to know that with consistent care, this is one of the most preventable health issues with the Shih Tzu breed. Here’s how to stay ahead of it:
#1 Brush daily
using a small, angled dog toothbrush or fingerbrush and vet-approved enzymatic toothpaste. A kit like
Vets Best Dog Dental Kit contains all of these; their triple-head brush works very well on dogs of all sizes and helps you quickly get the teeth clean.
#2 Offer a daily dental chew that is VOHC-approved (Veterinary Oral Health Council) to reduce plaque and tartar between brushings. A very popular one is Greenie Teenies, which is sized for dogs 5 to 15 lbs. As with any dental treat, supervise your sweetie so you can take away any pieces that may break off (these have a hard texture, by design).
#3 Incorporate dental wipes as a quick wipe-down as needed or for if your Shih Tzu won’t tolerate brushing. An effective one are the Teeth Cleaning Wipes by HICC Pet which uses organic coconut oil.
#4 Speak with your vet about professional cleanings. These are typically done under anesthesia to allow deep gumline cleaning and any necessary treatment. Because anesthesia is risky with Shih Tzus, the vet should do a benefit/risk analysis based on age, health, and dental status. When dental disease is present, this may be the best way to prevent pain, infection, and tooth loss; making prevention all the more important.
#5 Check teeth weekly for early signs of trouble like bleeding gums, dark tartar buildup, or loose teeth.
#3 Arthritis (Osteoarthritis)
Overview: Size & Structure = Arthritis (And, Not Just for Senior Dogs)
Osteoarthritis (OA) is a chronic, progressive degeneration of joint cartilage and adjacent bone, leading to pain, stiffness, and reduced mobility. While it often affects senior dogs, OA can begin much earlier, especially in breeds prone to conditions that stress joints (such as hip dysplasia) or other structural weaknesses.
Signs of OA:
Signs that a dog is already starting to have issues includes stiffness, especially (after rest or in the morning), reluctance to climb stairs, jump, or chase, slower walking pace or changed gait, tenderness when touching joints, muscle loss or reduced activity levels.
Stats:
Overall, studies estimate that osteoarthritis affects 20% to 35% of the general dog population [5]. One study found that 22.7% of toy/small breed dogs had radiographic evidence of OA [6]. With Shih Tzus, the hips are a commonly affected area.
Newer research suggests that up to 90% of dogs over age 5 may show clinical signs of arthritis [7]. This high number reflects how often arthritis may go undiagnosed, as researchers used activity trackers, imaging, and exams to uncover hidden cases. The findings challenge the idea that OA is just a senior dog issue and underscore the importance of monitoring earlier in adulthood.
How to Prevent This Health Issue:
Joint care should start early, long before the senior years. While osteoarthritis can’t be avoided entirely for many dogs, the right steps can delay when it starts and reduce how severe it becomes.
Here’s how to support your Shih Tzu’s long-term mobility:
#1 Keep your Shih Tzu’s weight at a healthy level to reduce joint stress and inflammation. If your adult is carrying a few extra pounds, there are stress-free ways to help a Shih Tzu lose weight including lower calorie treats and gradually increasing activity.
#2 Add a glucosamine and chondroitin supplement to support cartilage health. These compounds help maintain the cushioning between joints, reduce inflammation, and may slow the progression of arthritis. Look for high-quality joint supplements, ideally made in the US. One that we like a lot is Glucosamine Treats for Dogs by StellaLab which are made in the USA and also include Chondroitin, Omega-3 and 6, Yucca (to fight inflammation), and Vitamins E and C.
#3 Incorporate omega-3 fatty acids to ease inflammation. Sourced from fish oil, these healthy fats have been shown to reduce joint pain and stiffness by targeting inflammation at the source. They can also improve mobility and overall joint comfort over time. One that we really like is Zesty Paws Wild Alaskan Salmon Oil; this is superior than those sourced from farmed fish and it's easy to add a 1/2 pump to the dinner bowl.
#4 Provide daily low-impact exercise to help build muscle and maintain flexibility. Moderate paced walks are ideal for the Shih Tzu breed.
#5 Prevent jumping from heights. If your Shih Tzu likes to jump off furniture, consider pet steps or a pet ramp. We like the adjustable Wooden Ramp by Pawaboo which is also foldable and has great grips for little feet.
#6 Address underlying orthopedic issues early, such as luxating patella or hip dysplasia; early intervention helps slow progression.
#7 If OA is suspected, make a vet appointment asap. There are many treatment options including NSAIDs, pain-relief injections (e.g., Librela), or targeted rehabilitation modalities.
#4 Ear Infections
Overview: Floppy Ears = Frequent Infections
Shih Tzus have long, pendulous ears covered in dense hair, an anatomical trait that limits air circulation and creates an ideal environment for moisture, wax, and debris to accumulate. This can lead to otitis externa, an infection of the outer ear canal. Most ear infections are caused by an overgrowth of bacteria or yeast, often triggered by trapped moisture, allergies, or excess wax. The result is inflammation, irritation, and pain. Left untreated, these infections can become chronic and may impact hearing or overall comfort.
Signs of Ear Infections:
Signs of ear infection with Shih Tzu dogs include excessive scratching at the head or ears, head shaking, redness or swelling in the outer ear canal, a bad odor and/or ear discharge.
Stats:
Research shows that ear infections affect 7.3% of all dogs annually [8]. Dogs with pendulous (floppy) ears, like Shih Tzus, have approximately 76% higher odds of ear infections than dogs with erect ears [8].
Additionally, brachycephalic breeds show 25–30% higher prevalence of otitis externa (outer ear canal infection) compared to non-brachycephalic breeds [9].
In Shih Tzus specifically, 4.7% of veterinary visits (nearly 1 in 20) are due to ear infections—a rate significantly higher than in many other breeds [10].
How to Prevent This Health Issue:
Keeping your Shih Tzu’s ears clean and dry is one of the simplest ways to prevent painful infections, and it’s easier than you might think. With a few consistent habits, you can protect your sweetie from recurring irritation and costly vet visits.
#1 Inspect the ears weekly. Check for odor, redness, excess wax, or signs of discomfort. After baths or swimming, always dry the ears thoroughly using a thin, soft towel.
#2 Keep the outer ear canals free of dirt and debris. Using a gentle wipe like Pet MDs Ear Wipes, thoroughly clean the ear flaps as often as daily, but at least once a week.
#3 Clean the ear canals monthly, or as needed. Use a gentle, safe ear cleanser like Advanced Ear Cleanser by Virbac. Never insert cotton swabs, as they can push debris deeper into the canal and risk injury. If your Shih Tzu is prone to infections, your vet may recommend more frequent cleanings.
Quick Tip: Gently lift the ear flap and apply the cleanser into the canal as directed, then massage the base of the ear for about 20 seconds. Let your dog shake their head, then wipe away loosened debris with a soft gauze pad or cotton round.
#4 Address excess ear hair.
Long hairs in the ear canal and/or around the ear flaps can harbor moisture and bacteria. When you bring your Shih Tzu to the groomer for coat trims, taking care of these hairs should be included. But, if you do trims at home or are letting the coat grow out, a groomer or vet can show you how to keep this area tidy with plucking and/or trimming.
#5 Manage underlying allergies. Ear infections often go hand-in-hand with allergies. If your Shih Tzu has chronic ear issues, it's time to speak to the vet about identifying triggers and starting targeted treatment.
#6 If your Shih Tzu does develop an infection, and is given prescription medication, finish the full course of treatment even if the symptoms seem to clear up early. Stopping medication too soon can allow the infection to return, and often more stubborn than before.
#5 Skin Allergies
Overview: A Breed Prone to Sensitive Skin
Shih Tzus are one of the most allergy-prone breeds, and this can often manifest as skin reactions. Their coat of hair (as opposed to fur) and compact frame can trap allergens close to the body, while their genetic profile contributes to a heightened sensitivity to environmental triggers (like pollen, dust mites, or mold), food ingredients, and even flea bites.
When the immune system overreacts to these triggers, the skin becomes inflamed and itchy, leading to a cycle of scratching, licking, and secondary infections. Without intervention, chronic skin allergies can cause hair thinning, hot spots, odor, and serious discomfort.
Signs of Skin Reactions to Allergies:
Signs that allergies are causing skin issues include constant scratching, licking the paws or belly, red or irritated skin, greasy or flaky patches, hair thinning, hives, rashes, hot spots and/or strong skin odor.
Stats:
In some clinical studies, Shih Tzus have been shown to be disproportionately affected by environmental allergies. For instance, a Brazilian study found they accounted for 51.7 % of canine atopic dermatitis cases among small‑to‑medium breeds [11].
How to Help Prevent This Health Issue:
While you can’t always eliminate allergies entirely, you can drastically reduce flare-ups and discomfort with a strong prevention routine:
#1 Wipe down after outdoor time. Use gentle, hypo-allergenic grooming wipes like Earthbath Hypo-Allergenic Wipes or a damp cloth to remove allergens like pollen from your Shih Tzu’s coat and paws, especially after walks or playtime outside.
#2 Switch to an allergy-friendly shampoo that supports skin health. Bathe every 3 weeks or so, using a gentle, hypoallergenic, or medicated shampoo designed for sensitive skin. One that we love is Earthbath Hot Spot Relief Shampoo which has both Aloe and Tea Tree Oil; it's very soothing for irritated skin. Follow this with their Oatmeal and Aloe conditioner.
Note: The Oatmeal and Aloe formula (both shampoo and conditioner) is fantastic to help keep issues at bay.
#3 Feed a skin-support diet. Diet plays a major role. When
choosing food for your Shih Tzu, look for a recipe made with limited, high-quality ingredients, and with enhanced with skin-supportive nutrients like omega-3s and vitamin E. Steer very clear of any additives including artificial coloring, flavoring, or preservatives.
#4 Use omega-3 supplements for skin health. Fish oil-based supplements help reduce inflammation, relieve itching, and promote a healthy skin barrier. We recommend one that uses wild fish (not farmed) and one of our favorites is the aforementioned Zesty Paws Wild Alaskan Salmon Oil.
#5 Aim to identify triggers. There are a wide range of steps you can take at home to help reduce allergy triggers. If skin issues are frequent, your vet may recommend an elimination diet, allergy testing, or prescription treatments to keep symptoms under control.
Final Thoughts
Shih Tzus have specific health vulnerabilities, but many of the most common issues are preventable to some degree, with proactive care. Staying attentive to changes, building consistent routines, and responding early when something seems off can make a lasting difference.
Lists to Love: Treat Edition
The Healthiest Type of Cheese for a Shih Tzu - Is your Shih Tzu obsessed with cheese? See tips for selecting healthy cheese at the market and the best wholesome cheese-based dog treats, including a lactose-free options that's offers tons of flavor.
Treats for Shih Tzus with Sensitive Stomachs - Treats for Shih Tzus with Sensitive Stomachs - If your Shih Tzu has a tummy that’s quick to rumble, finding the right treat can feel like a guessing game. Thankfully, there are gentle goodies that still deliver lip-smacking flavor.
Beneficial Fish Treats for Shih Tzus - Don't let your Shih Tzu miss out on the powerful benefits of omega-3s. These wholesome fish snacks support healthy skin, a glossy coat, and smooth digestion, making them a smart addition to a Shih Tzu’s diet.
Lists to Love: Helpful Finds
Best Gadgets for a Shih Tzu - These cool devices, tools and other care items can make life so much easier for both you and your little cutie-pie. You'll wish you found them sooner.
Top 10 Care Items Under 10 - If you're looking for high quality, helpful care items while staying on a tight budget, this list is for you. Updated regularly and something for all ages.
List of the Best Scents for a Shih Tzu - Treat your little guy or gal to a luxurious coat spray for optimal hair health with some unique and amazing fragrances.
The Ultimate Toy Collection for Shih Tzus - Chase, chew, snuggle, repeat! From teething helpers to boredom busters, these toys bring entertainment, comfort, and tail-wagging fun to your Shih Tzu’s day.
Let's stay connected...
Take a quick moment to become an AllShihTzu Member; It's completely free. You'll receive a PDF Welcome Booklet and our friendly newsletters. You'll also be able to suggest a topic for us to write about. It's the best way for us to stay in touch, so we hope you'll join us today.
References: Cited Studies and Sources
Eye Studies
[1] O’Neill DG, Lee MM, Brodbelt DC, Church DB, Sanchez RF. Corneal ulcerative disease in dogs under primary veterinary care in England: epidemiology and clinical management. *Canine Genetics and Epidemiology*. 2017;4:4. doi:10.1186/s40575-017-0045-5
[2] O’Neill DG, Thomson RM, Church DB, et al. Corneal ulcerative disease in dogs under primary veterinary care in England: prevalence and risk factors. *Canine Genetics and Epidemiology*. 2017;4:4. doi:10.1186/s40575-017-0045-5 (see breed‑specific stats)
Dental Issue Studies
[3] Enlund KB, Brunius C, Hanson J, et al. Periodontal disease is the most common disease in dogs over 3 years of age, with a reported prevalence of 80–89%. Frontiers in Veterinary Science. 2020;7:298. doi:10.3389/fvets.2020.00298
[4] 2. Wallis C, Saito EK, Salt C, Holcombe LJ, Desforges NG. Association of periodontal disease with breed size, breed, weight, and age in pure‑bred client‑owned dogs in the United States. *Veterinary Journal*. 2021 Sep;275:105717. doi:10.1016/j.tvjl.2021.105717
OA Studies
[5] O’Neill DG, Pegram CLJ, Church DB, Brodbelt DC. Prevalence, duration and risk factors for appendicular osteoarthritis in dogs under primary veterinary care in the UK. Veterinary Record. 2014;175(8):185. doi:10.1136/vr.101779. PMID: 24532271.
[6] Enomoto M, de Castro N, Hash J, et al. Prevalence of radiographic appendicular osteoarthritis and associated clinical signs in young dogs. Scientific Reports. 2024;14:2827. doi:10.1038/s41598-024-52324-9.
[7] Marshall WG, Brown DC, Boston RC. Physical activity patterns of free-living dogs diagnosed with osteoarthritis. BMC Veterinary Research. 2021;17:124. doi:10.1186/s12917-021-02843-y.
Ear Infection Studies
[8] O’Neill DG, Lee MM, Brodbelt DC, Church DB, Sanchez RF, Pegram C. Epidemiology of otitis externa in dogs under primary veterinary care in the UK. Canine Medicine and Genetics. 2021;8(1):1–11.
[9] Hayes G, Friend E, Deal C, Torrance A. Brachycephalic breed predisposition to otitis externa in dogs under primary veterinary care in the UK. Veterinary Dermatology. 2021;32(2):97–e24.
[10] O’Neill DG, Pegram C, Brodbelt DC, Church DB, Sanchez RF. Breed distribution and risk factors for veterinary presentation of otitis externa in dogs in the UK. Journal of Small Animal Practice. 2021;62(5):348–357.
Skin Allergy Study
[11] Couceiro GA, Ribeiro SMM, Monteiro MM, Meneses AMC, Sousa SKSA, Coutinho LN. Prevalence of canine atopic dermatitis at the Veterinary Hospital of the “Universidade Federal Rural da Amazônia” in Belém/Pará, Brazil. Pesquisa Veterinária Brasileira. 2021;41:e06778. doi:10.1590/1678‑5150‑PVB‑6778