Shih Tzu health begins with the companion-dog face in the mirror: short muzzle, prominent round eyes, a small jaw packed with teeth, and floppy, hairy ears. That cherished arrangement shapes the breed's everyday veterinary needs far more than size or temperament does, which is why eyes, breathing, mouth and ears dominate the guidance below, with joints and kidneys covered in their own section. Knowing which feature drives which risk helps you turn grooming time into a quiet health check and bring small changes to your vet while they are still small.
Eyes First: Corneal Ulcers and Dry Eye
Shih Tzu eyes sit in shallow sockets, so they are prominent, exposed, and easier to injure than the eyes of a longer-faced dog. Corneal ulcers are sores on the clear front surface of the eye, caused by a scratch, a knock, hair rubbing, or a grass seed, and their signs are unmistakable once known: squinting or holding the eye shut, watering, pawing at the face, redness, or a cloudy or dull patch on the eye surface. Treat any such eye as same-day urgent. Do not wait for it to clear, and do not use leftover eye drops; a vet needs to stain and examine the eye to see the damage and direct treatment.
Dry eye means the eye is not producing enough tears to stay protected, and in a breed with exposed eyes that gap matters quickly. Look for thick sticky discharge, repeated redness, a dull surface, or ulcers that keep returning, and expect your vet to measure tear production with a simple strip test. Long hair falling over the eyes adds irritation, so keep the fringe trimmed or tied as your vet or groomer advises, and check both eyes during grooming while the dog is calm and the light is good.
Airway, Teeth and Ears
Brachycephalic airway problems come from the shortened skull: noisy breathing, snorting, snoring, gagging, and tiring quickly are the everyday signs, and heat makes breathing harder, so walks belong in cool hours, exercise stays gentle, and a dog struggling to breathe or cool down needs a clinic at once. Your vet grades breathing at routine visits and can discuss what your dog's airway means for exercise, weight, and anaesthesia.
Dental crowding packs a full set of teeth into a small jaw, trapping plaque where a brush reaches poorly. Dental disease follows: bad breath, tartar, red gums, dropped food, or chewing on one side. Expect mouth checks at every visit and follow your vet's advice on home brushing built up gradually. Ear infections thrive in hairy, floppy ears that hold warmth and moisture; watch for head shaking, ear scratching, redness, dark discharge, or a sour smell, and let your vet look down the ear rather than treating the surface repeatedly at home.
Kneecaps and Kidneys
Patellar luxation is a kneecap that slips from its groove, seen as a brief skip or a hind leg carried for a few steps, reluctance to jump, or stiffness after rest; a vet feels the kneecaps at examination and grades how freely each moves. Kidney dysplasia, reported in the breed, is abnormal kidney development that a vet investigates where a young dog drinks and urinates more, grows poorly, or has low appetite and energy; blood and urine testing are the screening route, so report changes in drinking early rather than treating them as a phase. Both findings reward early notes: a skip recorded with its date and a drinking change measured rather than guessed give your vet a timeline to work from instead of an impression. Eye results, mouth findings, kneecap grades and kidney values accumulate across years, and KinsLe keeps them ordered in its Pet Passport for whichever vet you see next.