A Shih Tzu breeder I know keeps a laminated chart on her kitchen wall: it’s a timeline of common health issues, organized by age. By year two, she’s already watching for eye problems. By year four, she’s listening for breathing changes. By year seven, she’s noting any shift in how the dog moves. It’s not morbid—it’s the opposite. It’s how you catch things early, when they’re still manageable.
Shih Tzus typically live 10 to 18 years, which is genuinely enviable in dog terms. But that long life happens inside a small, flat-faced body with a lot of hair, and that combination comes with a specific set of vulnerabilities. If you’re bringing a Shih Tzu into your home—whether you’re looking at shih tzu puppies from a reputable breeder or adopting a shih tzu dog mix—knowing what to watch for isn’t pessimism. It’s responsible ownership.
The Flat Face Problem: Breathing and Temperature Regulation
Let’s start with the most obvious one. Shih Tzus have been bred for a short, pushed-in muzzle—it’s the breed standard, and it’s adorable. It’s also a structural reality that affects how they breathe.
Brachycephalic airway syndrome is real. If your Shih Tzu is making snoring sounds louder than a human, struggling during play, or panting heavily in mild weather, those are signs the airway is compromised. Some Shih Tzus manage fine; others need surgical correction to breathe properly. Talk to your vet about what’s normal snoring and what’s a red flag. The difference between endearing and problematic is worth understanding early.
Temperature regulation is the second piece. Shih Tzus overheat quickly—their flat faces don’t cool air efficiently before it hits the lungs. Summer walks, hot cars (never), and even long grooming sessions can push them into heat stress. Watch for excessive panting, drooling, lethargy, or vomiting. These aren’t minor symptoms. If your Shih Tzu suddenly acts off on a warm day, call your vet.
This also means breed-appropriate exercise. A Shih Tzu doesn’t need hours of running—that’s actually not realistic or safe for them. Two short walks daily, morning and evening when it’s cooler, is more sensible than one long afternoon hike. Knowing your shih tzu’s schedule and climate needs is as important as knowing shih tzu dog price.
Eye Issues: From Scratches to Progressive Disease
Shih Tzus have large, prominent eyes—another breed hallmark, another potential problem. That gorgeous round stare sits forward, exposed to dust, trauma, and dryness.
Corneal ulcers and scratches happen more often in this breed than in dogs with longer muzzles and more facial protection. If you notice squinting, excessive tearing, cloudiness, or your Shih Tzu keeping an eye closed, don’t wait. These can deteriorate quickly, especially in a breed prone to aggressive eye infections.
Dry eye (keratoconjunctivitis sicca) develops in some Shih Tzus, particularly as they age. You’ll notice crusty discharge, redness, or a matte appearance to the eye instead of the normal shine. This is manageable with medication, but untreated, it leads to scarring and vision loss. Talk to your vet about screening for dry eye, especially if you’re noticing changes.
Progressive retinal atrophy (PRA) is a genetic condition that causes blindness over time. It’s usually slow—years—but it happens. There’s no cure, though a Shih Tzu can adapt remarkably well to blindness if the rest of their environment stays consistent. Responsible breeders screen for it. If you’re buying from someone and they haven’t done PRA screening, that’s a red flag. If you’re adopting, know it as a possibility and plan accordingly.
Daily eye checks take 30 seconds. Look for redness, discharge, or any cloudiness. Wipe gently with a damp cloth if needed. It’s preventive care that costs nothing and catches infections before they escalate.
Ear Infections and That Grooming Schedule
The Shih Tzu’s long coat and floppy ears create a perfect storm for moisture and yeast. Combined with a warm, hairy ear canal, infections are almost inevitable without routine cleaning.
If your Shih Tzu is shaking their head frequently, scratching at their ears, or you’re smelling something foul from the ear canal, that’s infection. It happens fast in this breed. Some Shih Tzus get chronic ear issues—recurring every few weeks—which suggests a deeper problem. Talk to your vet about ruling out allergies or other underlying causes, not just treating the infection itself.
Here’s where shih tzu schedule comes in practically: grooming every 6 to 8 weeks isn’t luxe—it’s health maintenance. Long, matted hair traps moisture and bacteria. If you’re not committing to that schedule, you’re setting your dog up for ear, skin, and eye problems. Between professional grooming, you can learn to hand-strip or clip the ear hair to keep the canal dry. Yes, it’s an investment of time or money. It’s also non-negotiable for this breed.
Ear cleaning at home—even just weekly with a vet-approved solution—reduces infection frequency significantly. It’s the kind of preventive care that actually works.
Patellar Luxation and Joint Health
Small-breed knee problems are common, but Shih Tzus have a particular susceptibility to patellar luxation—the kneecap slipping out of its groove. It ranges from a nuisance (the dog yelps occasionally) to severe (the dog can’t bear weight, needs surgery).
Watch for occasional limping, reluctance to jump or use stairs, or your dog suddenly crying out and then walking normally moments later. Those are classic signs. Some dogs are born with it; others develop it from injury or strain. Jumping off furniture repeatedly, especially in young dogs, increases risk.
Not every Shih Tzu will have patellar luxation, but screening matters. Reputable breeders test for it. If you’re considering a shih tzu dog price, factor in the likelihood of orthopedic costs. Pet insurance becomes particularly relevant here—a patellar luxation surgery can cost $1,500 to $3,000 per knee.
Keep your Shih Tzu lean. Excess weight hammers small joints. Ramps and steps for bed/furniture access reduce jump strain. Swimming or walking on soft surfaces is gentler than concrete sidewalks.
Dental Disease and Prevention
This breed’s small mouth, crowded teeth, and floppy lips create an environment where bacteria thrive. Dental disease in Shih Tzus isn’t cosmetic—it’s systemic. Untreated tooth decay and gum infection contribute to kidney and heart disease over time.
Brush teeth daily if possible, at least 4 to 5 times weekly. This actually works. Dental chews help but don’t replace brushing. Professional cleanings start around $500 to $1,200 depending on your region and the dog’s existing disease, and most Shih Tzus need them every 12 to 18 months after age 5.
Tooth loss isn’t inevitable if you prioritize prevention. But ignoring dental health, then acting surprised when your 8-year-old Shih Tzu needs multiple extractions? That’s avoidable.
Insurance and Honest Cost Expectations
A healthy Shih Tzu from a responsible breeder costs $1,500 to $3,500—significantly more than what puppy mills or backyard breeders charge. There’s a reason. Health screening, proper socialization, and ethical breeding practices cost money. Cheaper is almost always a financial trap; you’re buying future vet bills.
Pet insurance for a Shih Tzu typically runs $30 to $50 monthly depending on coverage and deductible. Over a 15-year lifespan, that’s $5,400 to $9,000. A single eye surgery, knee repair, or extended treatment for an ear infection can exceed that in one year. Insurance isn’t perfect—it reimburses rather than covering upfront, and breed-specific conditions sometimes fall under exclusions—but for a breed with predictable health costs, it’s sensible.
The alternative is an emergency fund of at least $2,000 to $3,000 that you don’t touch for anything else. Most people aren’t disciplined enough to maintain that. Insurance forces the commitment.
Talk to your vet about which insurance offers good Shih Tzu coverage; they often have feedback from owners’ claims history. Ask about hereditary condition coverage specifically.
Health vigilance means catching problems early, managing them affordably, and giving your Shih Tzu the long, comfortable life this breed is capable of living.
