Breed Health

The Shih Tzu is an active, entertaining little dog which generally enjoys a long and healthy life. Although there are no serious widespread health problems in the breed, there are conditions being reported that breed health co-ordinators are monitoring and breeders should be up to speed with. There are also some more day to day potential issues that owners need to be mindful of.

Nothing written here is intended to contradict the professional opinion of a vet who has examined your dog. It reflects the acquired wisdom of long time owners and breeders (and their vets) and is given as general advice only.

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Eye Injuries and Infections

With their large forward facing eyes and short muzzle, Shih Tzu are prone to picking up knocks and injuries to their eyes. Most eye injuries can be very successfully treated, the quicker veterinary help is sought the better the chances of a full recovery. A daily check of your Shih Tzu's eyes, accompanied by a quick wipe to keep them clear of any build up, is usually sufficient to spot anything untoward and to allow prompt treatment. After an injury the affected eye often starts to take on a bluish tint. It isn't always possible to see the injury itself immediately. When an eye has an infection, such as conjunctivitis, it will often appear inflamed and you may notice more blinking or winking. Eye injuries and infections can be very painful and you should seek veterinary help as soon as you can.


There are a number of different type of hernia but the two most often come across in Shih Tzu are Umbilical and Inguinal. A hernia is a protrusion of body tissue, fat or organ through an abnormal opening in the surrounding tissue. Usually the protrusion or bulge can be pushed back in and this is known as reducible. If not then it called incarcerated. If the blood supply to an incarcerated hernia is cut off then the hernia becomes strangulated. Although an uncommon occurrence a strangulated hernia is a medical emergency requiring swift veterinary treatment. A hernia should always be pointed out to you and discussed by a responsible breeder when choosing a puppy.

Umbilical hernias are fairly common in our breed. A Shih Tzu with an umbilical hernia will have a bulge in the middle of the tummy, where the umbilical cord was attached, caused by an incompletely closed umbilical ring. Although inheritance likely has an influence in some cases, the majority of umbilical hernias are believed to be caused by the umbilical cord being severed too close to the abdominal wall at birth. Most umbilical hernias are small and will get smaller as a puppy grows. In many cases they will disappear completely by the time a puppy is several months old. Umbilical hernias rarely require surgical intervention before this age but a larger hernia might require repair. This is often convenient to do at the time of neutering. Breeding opinions do vary but generally if a hernia is large enough to require surgery then the dog should not be bred from. If a dog has a small hernia then it is ok to breed on with but, as any modes of inheritance are poorly understood, the breeding should not be repeated if significant numbers of puppies are born with hernias.

Inguinal hernias are less common but more likely to require corrective surgery if they don't disappear as the puppy grows. They are caused by tissue or abdominal organs protruding through the inguinal ring and show up as bulges in the groin area either on one side or both. They are more common in females but do occur in both. Inguinal hernias are more likely to be a hereditary condition so dogs with them are more likely to pass them on and could possibly suffer increased risk of complications in pregnancy so should not be bred from.


Dogs with a shortened skull will often have a shortened jaw, but the number and size of teeth will stay the same. This can mean that the teeth become overcrowded and can cause dental and gum problems. Shih Tzu do sometimes lose teeth as they get older but don't often suffer serious dental issues.

Dry Eye

Dry eye (Keratoconjunctivitis Sicca) occurs when the tear glands don't produce enough tears to keep the eye surface sufficiently lubricated. It is a common condition in dogs and, untreated can result in corneal ulceration and eye infection which can lead eventually to blindness.

Sometimes dry eye is a temporary issue that the dog will recover from following treatment but it can also be a lifelong condition requiring careful management.

Further reading about Dry Eye. (opens in new window)

Bladder Stones

There are different types of bladder stones. One - Struvite - overwhelmingly affects bitches, around 85% of cases involve females. Another - Oxalate - is more common in males. Symptoms include difficulty passing urine, blood in the urine and repeated urine infections. Some stones may be passed in urine but often surgery is required. Recurrence can often be minimised by controlling diet.

Further reading about bladder stones. (opens in a new window)

Progressive Retinal Atrophy (PRA)

PRA is an incurable degenerative eye disease than can generally start showing symptoms from the age of 6 - 7. The first signs are an increasing night blindness which progresses with varying speed to complete blindness unless the dog dies of old age beforehand. All breeds can be affected by PRA and it is known to exist in Shih Tzu although it is not currently thought to be widespread. For the moment it is a difficult condition for breeders to manage because of it's frequently later life onset. Once symptoms become apparent PRA can be diagnosed by a veterinary ophthalmologist. DNA tests are becoming available but they are breed specific with none yet available for Shih Tzu.

Further reading about PRA. (opens in a new window

Renal Dysplasia

Renal Dyplasia is a defect of the kidneys - with either a developmental or genetic cause. In the defect, kidney cells (nephrons) either do not mature correctly immediately after birth or are replaced with fibrous tissue. Over time this results in progressively reduced kidney function until at some stage symptoms - excessive drinking and urination along with weight loss and lack of energy - become noticeable. If the condition progresses renal failure is the last stage. Affected dogs may succumb to kidney failure as fairly young puppies but many may never show a clinical symptom in their lives.

Although largely an inherited condition, the mode of inheritance has been difficult to determine although with modern DNA sequencing we are finally starting to make progress in understanding the condition.

Further reading on Renal Dysplasia (opens in a new window)

Pinched Nostrils & Soft Palate

Many Shih Tzu puppies' nostrils can be a bit pinched when they are teething, they sound snuffly and they may blow the odd clear bubbles fro their nose. This is due to the swelling involved with cutting new teeth. Most of them grow out of it when their adult teeth finish coming though, usually by around 6 months of age. A small minority do need surgery but most get much better without any intervention. If a puppy is obviously struggling to breathe, is lethargic and/or has green mucus around its nose then a veterinary intervention may be necessary earlier but otherwise it is best to wait and see. The soft tissue in the nose and throat of some brachycephalic dogs may be excessive for the airways, making it difficult for them to breathe normally (causing heavy panting or noisy breathing). More information about brachycephalic breathing problems can be found at

Allergies and Intolerances

Although not as widespread as in some breeds, allergies or intolerances seem to be fairly common in Shih Tzu. Strictly speaking an allergy is less common and more serious than an intolerance but the two terms can get mixed up. Intolerances can take many forms but the most obvious symptom is usually scratching and/or sore skin. It is best to consult your vet in the first instance, especially if the skin is sore or infected. Sometimes a dietary intolerance will be shown by a tummy upset, but not always.
If your Shih Tzu is scratching and you have ruled out more obvious causes - such as fleas and ticks, abscesses and other skin infections - then it is likely your dog is sensitive to something he is in regular contact with. In a typical home the most likely issues are one or more of diet, dust/house mites and possibly the shampoo he is bathed in. Our experience is that most problems are caused by something the dog's diet not agreeing. Wheat is the most common offender but some dogs are sensitive to certain meats. Look carefully at the ingredients in your dog's food. Many mainstream kibbles contain lots of wheat or other cereals. Try feeding a hypoallergenic variety and experiment over a period a several weeks. Pay particular attention also to the treats you feed. Your vet will be able to help with a special diet but if you can pin down the ingredient causing the issue you can usually find suitable foods without the specialist high price tag.

Further reading about Feeding and Diet.

Ear Problems

Shih Tzu are no more prone than any other dog to have ear infections. They do, however, grow hair inside their ears which needs to be removed periodically to help keep the ears clean. The most common problem is ear mites. They are usually picked up from direct contact with another dog. They make your dogs ears itch and secrete a brown waxy substance. Veterinary treatment is simple but should be sought quickly as the longer an infestation is untreated the greater the likelihood of secondary complications such as infections. Check you Shih Tzu's ears regularly to make sure they are clean.

Autoimmune Diseases

Autoimmune diseases are being reported in all dogs, including Shih Tzu. No one is sure what triggers the immune system to begin attacking normal body tissue. Some blame vaccination, others say environmental pollutants or food preservatives. Some questions have been raised about good hygiene itself being a factor (Hygiene Hypothesis). There is also evidence for a genetic predisposition. There are a whole range of autoimmune diseases that seem to be on the increase in dogs similar to humans, which may indicate that environmental factors could be a significant influence. Currently we just don't know.


Diabetes is quite a well known condition affecting pets. It doesn't seem to be common in Shih Tzu. It can strike as young as 18 months old but more commonly starts between 7 and 10 years old. Over two thirds of diabetic dogs are female. Clinical signs to look out for include increased drinking and urination, weight loss despite good appetite and the sudden appearance of cataracts in the eyes. Clinical diagnosis is fairly simple and although the treatment is fairly demanding the long term outlook for a diabetic dog is pretty good - provided diagnosis and treatment are started early.

Further reading about Diabetes (opens in a new window)

Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) is a chronic intestinal problem. Regular bouts of diarrhoea are the most common symptom. There is no cure but symptoms can be managed with diet sometimes in conjunction with steroids.

Further reading about IBD. (opens in a new window)

Autoimmune Haemolytic Anaemia

In this condition the immune system attacks red blood cells, decreasing the oxygen carrying capacity of the blood. The clinical signs are related to lack of oxygen - weakness, lethargy, increased breathing and heart rate. Pale gums or other mucous membranes may also be observed. Usually the signs are gradual but in some cases a dog can collapse suddenly in an acute crisis. High dose corticosteroids are the primary treatment to stabilise the condition gradually reducing over time. Spleen removal is an option is severe cases. Relapses can happen and the condition can be fatal if the immune system cannot be sufficiently suppressed in good time.

Further reading on Autoimmune Haemolytic Anaemia. (opens in new window)

Immune Mediated Thrombocytopaenia

In this condition the immune system attacks the thrombocytes, or blood clotting cells in a similar way that AIHA attacks red blood cells. Clinical signs include bruising, blood in urine or faeces, bleeding gums or from other injuries. As there are a number of other diseases that prevent blood clotting, diagnosis has to rule those out first. Treatment is similar to AIHA although surgical options are more limited due to poor clotting. The prognosis for IMT is usually better than for AIHA.

Further reading for Immune Mediated Thrombocytopaenia (opens in new window)