Why Shih Tzus Get These Specific Problems
Most Shih Tzu health issues trace back to the same source: their body shape. Short legs, a compact frame, and a flat face aren’t just a look, they’re the reason certain conditions show up in this breed far more often than in dogs built differently. A peer-reviewed epidemiological study of Shih Tzus under primary veterinary care in the UK, published via PMC, documented exactly this pattern across a large real-world population of the breed.
Joint and Orthopedic Issues
Dogster explains this is a dislocating kneecap, graded in four levels of severity. Watch for a Shih Tzu suddenly skipping or holding up a back leg mid-stride, then walking normally again seconds later.
Uneven bone development can cause joint instability over time, leading to discomfort and, eventually, degenerative joint disease if unmanaged.
Intervertebral disc disease is linked to the same genetics behind the Shih Tzu’s short-legged build. Discs degenerate and can bulge or rupture, causing pain or mobility issues depending on the spinal level affected.
Brachycephalic Airway Syndrome
Flat-faced breeds like Shih Tzus commonly have narrowed nostrils, an elongated soft palate, and a narrower windpipe than dogs with a longer muzzle. Together these make breathing measurably harder, especially in heat, during exercise, or when overweight.
Signs include loud snoring, noisy breathing at rest, heavy panting, and tiring quickly on walks. It’s easy to write this off as “just how Shih Tzus sound,” but severity varies a lot between individual dogs, and it can worsen gradually. Keeping a healthy weight measurably helps, since extra weight makes already-restricted breathing even harder.
Eye Conditions
The same flat-faced structure that affects breathing also means Shih Tzu eyes sit more exposed than in non-brachycephalic breeds. The PMC study found brachycephalic dogs face substantially higher odds of corneal ulcers compared to non-brachycephalic breeds, and identified Shih Tzus specifically as among the breeds with the highest rates of corneal ulcerative disease and prolapse of the third eyelid gland (commonly called “cherry eye”).
Dental Crowding
A small jaw fitting a full set of teeth means overcrowding is common, which creates more surface area for plaque and tartar to build up than in dogs with more evenly spaced teeth. This is exactly why dental care tends to need more attention in this breed, not less, despite their small mouths looking easier to manage.
Ear Infections
Floppy ears combined with hair growth inside the ear canal create a warm, low-airflow environment that infections like. Head shaking, scratching at the ears, odor, or visible discharge are the signs to watch for, and these are frequently mistaken for seasonal allergies instead of an active infection.
Anal Gland and Digestive Issues
The UK study specifically flagged Shih Tzus as being at increased risk of anal sac disorders compared to crossbred dogs. Most dogs need occasional professional help expressing these glands, and increasing dietary fiber can help produce firmer stools that naturally assist the process.
When to Actually Worry
Monitor, mention at next visit
- Occasional mild snoring
- A single skip-step that resolves instantly
- Mild, infrequent scooting
- Normal seasonal shedding or coat changes
Call the vet
- Labored breathing or blue-tinged gums
- Frequent limping or a leg that stays raised
- Squinting, redness, or visible eye pain
- Persistent ear odor or discharge
- Sudden weight loss, vomiting, or lethargy
The Bottom Line
None of this means a Shih Tzu is a fragile or unhealthy breed, most live full, active lives. It means their specific body shape comes with specific, well-documented tendencies, and knowing what those are means you catch problems early instead of writing off real symptoms as quirks. Cooper’s snoring turned out to be genuinely mild. I still keep an ear out for it getting louder.
Sources & References
- PMC: Demography, Common Disorders and Mortality of Shih Tzu Dogs Under Primary Veterinary Care in the UK (peer-reviewed)
- Dogster: The Most Common Shih Tzu Health Problems to Watch Out For (Vet-Reviewed)
- Hepper: 13 Vet-Verified Common Shih Tzu Health Issues
- Long Beach Animal Hospital: Diseases for Shih Tzu
