Shih Tzus are one of Australia's most beloved apartment and urban companions. With their expressive eyes, silky coats, and endlessly affectionate nature, it is easy to see why. They are small enough for a studio flat, calm enough for quieter households, and devoted enough to become the centre of your world within days of arriving home.
But that distinctive flat-faced, compact frame comes with a set of inherited health tendencies that every Shih Tzu owner should understand. Not because this breed is fragile, quite the opposite: a well-cared-for Shih Tzu regularly lives 13 to 16 years. Understanding the most common Shih Tzu health problems in Australia means you can catch issues early, manage them well, and give your dog the long, comfortable life they deserve.
This guide covers the conditions your vet is most likely to discuss with you, what the warning signs look like, and what proactive care can do to keep your Shih Tzu thriving.
Brachycephalic Obstructive Airway Syndrome (BOAS)
BOAS is the most significant health concern for Shih Tzus, and it is tied directly to the features that make the breed so distinctive. The shortened skull and flattened face that give Shih Tzus their charming expression also compress the airway structures. Narrowed nostrils, an elongated soft palate, and a relatively narrow trachea all restrict airflow and make breathing harder work than it should be.
In Australia, this matters particularly during summer. Shih Tzus in Queensland, Western Australia, and along the eastern seaboard face heat and humidity that can tip manageable breathing difficulties into serious distress. Even a mild case of BOAS becomes much more dangerous at 35 degrees.
Signs to watch for include loud snoring (even when awake), noisy breathing at rest, excessive panting after minimal exertion, reluctance to walk or play in warm weather, and open-mouth breathing that persists even when calm. In severe cases, gums may take on a bluish tinge, which is a sign of oxygen deficit and requires emergency vet attention.
Not every Shih Tzu with BOAS needs surgery, but every one benefits from management. Keep walks to early morning or evening during warm months. Avoid leaving your dog in cars or enclosed spaces. If your vet identifies a moderate or severe case, corrective surgery to widen the nostrils or shorten the soft palate can make a meaningful difference to your dog's quality of life. Research published in veterinary practice literature consistently shows that early surgical intervention in younger dogs produces better long-term outcomes.
Dental Disease
Dental disease is the most common health problem across all small breeds in Australia, and Shih Tzus are particularly vulnerable. Their small mouths create crowded teeth that trap food and plaque in tight spaces that are almost impossible to clean without deliberate daily effort. Many Shih Tzus also have an undershot jaw (where the lower jaw protrudes slightly past the upper), which worsens the crowding problem.
Plaque hardens into tartar within 72 hours if left undisturbed. Over time, tartar leads to gingivitis, then periodontal disease, then tooth root infections. Beyond the mouth, advanced dental disease has been linked to kidney and heart problems in small dogs, as bacteria from the gums enter the bloodstream.
The good news: dental disease is almost entirely preventable with consistent daily brushing using a dog-safe toothpaste and toothbrush. Start when your Shih Tzu is a puppy so they accept it as a normal part of life. Annual professional dental cleans under anaesthetic allow your vet to scale below the gumline and catch problems early. Dental chews and water additives can help but do not replace brushing.
If you notice your dog pawing at their mouth, dropping food, chewing on one side, or having breath that has worsened suddenly, book a dental examination. Tooth pain in dogs is often silent until it becomes severe.
Eye Conditions
Shih Tzu eyes are prominent and shallow-set, which gives them that wide, expressive appearance but also leaves the eyes more exposed and more vulnerable to injury and disease. According to research published in the journal of veterinary ophthalmology, Shih Tzus show a significantly higher prevalence of several eye conditions compared to most other breeds.
The most common eye issues in Shih Tzus include:
- Corneal ulcers: Scratches or abrasions on the surface of the eye that can become infected quickly. Even small wounds can be serious in this breed because the eyes protrude and cannot be covered fully by the eyelids during sleep.
- Dry eye (keratoconjunctivitis sicca): Reduced tear production causes painful dryness and increases the risk of corneal damage. Treatment typically involves daily lubricating eye drops or medication to stimulate tear production.
- Progressive retinal atrophy (PRA): A genetic condition where the retina degenerates over time, eventually leading to blindness. There is no cure, but ethical breeders test for it. Affected dogs adapt well with familiar environments.
- Proptosis: In rare but serious cases, the eye can be dislodged from the socket, usually following trauma or rough handling. This is an emergency requiring immediate veterinary care.
Check your Shih Tzu's eyes daily. Any redness, cloudiness, discharge, or squinting warrants a vet visit, ideally within 24 hours. Keeping the hair around the eyes trimmed is also important: long facial hair causes epiphora (tear staining) and can scratch the corneal surface.
Luxating Patella
Luxating patella, or a slipping kneecap, is a common orthopaedic problem in small breeds, and Shih Tzus are among the breeds most frequently affected. The kneecap normally sits in a groove at the front of the femur and slides smoothly during movement. In dogs with luxating patella, the groove is too shallow or misaligned, and the kneecap pops out of position.
You may notice your Shih Tzu suddenly lifting a back leg and hopping for a few steps, then placing it down normally again. This is the classic sign: the kneecap slips out, causes brief discomfort, then pops back in. Mild cases are common and may only require monitoring. More severe cases cause persistent lameness and can accelerate the development of arthritis and joint damage if left unaddressed.
Vets grade luxating patella from 1 (occasional slipping, returns on its own) to 4 (permanent dislocation). Grade 1 and 2 cases are typically managed with weight control, controlled exercise, and monitoring. Grade 3 and 4 cases often require surgical correction. Early diagnosis at a routine vet check is far better than waiting until the condition worsens.
Maintaining a healthy body weight is one of the best ways to reduce stress on the knees. Every extra gram puts additional load on joints that are already structurally challenged in this breed. For Shih Tzus already showing early joint changes, there are daily supplement options worth discussing with your vet, such as those that support cartilage and joint comfort.
Ear Infections
Shih Tzus have floppy ears with hair-filled canals, which creates a warm, moist environment that bacteria and yeast find very hospitable. Regular ear infections (otitis externa) are among the conditions vets in Australia see most frequently in this breed.
Symptoms include head shaking, scratching at the ears, a noticeable odour from the ear canal, redness or swelling of the ear flap, and dark discharge. Left untreated, infections can travel deeper into the ear, causing significant pain and potentially affecting hearing.
Prevention is straightforward: check the ears weekly, clean them with a vet-recommended ear cleaning solution, and have the hair in the ear canal plucked regularly by a groomer or vet. Never use cotton buds inside the canal. After swimming or bathing, gently dry the outer ear with a soft cloth.
If your Shih Tzu has recurring ear infections, ask your vet about underlying causes. Allergies are a frequent trigger. Addressing the allergy often reduces the frequency of infections significantly. You can learn more about managing this in the guide to ear infections in Shih Tzus.
Skin Allergies
Shih Tzus are prone to environmental and food allergies that manifest primarily through the skin. You might notice your dog scratching persistently at the same spots, licking their paws repetitively, rubbing their face on carpet or furniture, or developing red, irritated patches of skin. The belly, groin, armpits, and between the toes are the most common hotspots.
Atopic dermatitis (environmental allergy, often triggered by grass pollen, dust mites, or mould) is one of the most common diagnoses in this breed. Food allergies, while less common, are worth investigating if skin issues are year-round rather than seasonal. The most common food allergens in dogs are proteins: beef, chicken, dairy, and wheat are the most frequently implicated.
Diagnosis typically involves an elimination diet trial (over eight to twelve weeks) to rule out food allergies, and sometimes allergy testing for environmental triggers. Treatment ranges from specialised diets and antihistamines to veterinary prescription options for more severe cases.
Gut health plays a role here too. The gut-skin axis is well-documented in veterinary medicine: a balanced gut microbiome supports immune regulation, which in turn affects how strongly the body reacts to allergens. If your Shih Tzu has ongoing skin sensitivities, supporting their digestive health is worth discussing with your vet alongside skin-directed treatments.
Hypothyroidism
Hypothyroidism occurs when the thyroid gland produces insufficient amounts of thyroid hormone, slowing the body's metabolism. While it is less commonly discussed than BOAS or dental disease, hypothyroidism is a recognised condition in Shih Tzus and tends to appear in middle-aged to older dogs.
The signs are easy to miss because they develop gradually. Your dog may gain weight despite no change in diet, become less energetic or eager to exercise, develop a dull, dry coat, or show patches of hair thinning particularly along the trunk. Some dogs develop skin thickening or a slightly swollen face.
Diagnosis requires a blood test to measure thyroid hormone levels. The good news is that hypothyroidism is very manageable: daily oral thyroid hormone replacement therapy brings most affected dogs back to normal within a few weeks. Once diagnosed, dogs typically need treatment for life, but the cost and burden are low and the response is usually excellent.
Gut Health and Digestive Sensitivities
Shih Tzus can be sensitive to dietary changes and are more likely than many breeds to experience digestive upsets when their food is switched abruptly or when stress disrupts their routine. Loose stools, flatulence, and intermittent vomiting are common complaints among Shih Tzu owners, particularly in younger dogs and seniors.
Their small size also means blood sugar can drop quickly between meals, especially in puppies. Feeding two or three smaller meals per day rather than one large meal helps maintain stable energy levels and reduces the risk of hypoglycaemia.
A healthy gut microbiome underpins a great deal of a dog's overall health, from immune function to coat quality to mood. Shih Tzus with frequent digestive upsets, skin issues, or a history of antibiotic use often benefit from targeted gut support as part of their daily routine. Hero's Probiotic Daily Chews use Saccharomyces boulardii, a yeast-based probiotic that is antibiotic-safe and supports digestive resilience and immune function. It is a different approach to the bacterial probiotics you will see elsewhere, designed to work alongside a healthy gut rather than compete for space in it.
Kidney Disease
Chronic kidney disease (CKD) is more common in small breeds than in large dogs, and Shih Tzus have a known predisposition. The kidneys lose function gradually over years, and because the body compensates well early on, signs often do not appear until significant function has been lost.
Early signs include increased thirst, increased urination, reduced appetite, weight loss, and occasional vomiting. Later-stage disease brings lethargy, bad breath with an ammonia-like quality, and sometimes mouth ulcers.
Blood and urine tests as part of your annual vet check can detect early kidney changes well before symptoms appear. This is one of the strongest arguments for not skipping annual health checks for your Shih Tzu, even when they seem perfectly well. Catching CKD early opens up options that can significantly slow progression: dietary modification, hydration support, and targeted medical management.
The Bottom Line
Shih Tzus are a genuinely resilient and long-lived breed when their specific health needs are understood and addressed proactively. The issues covered in this guide are not reasons to avoid the breed. They are the things that distinguish attentive, well-prepared owners from those who are caught off guard when problems emerge.
Annual vet checks, daily dental care, consistent eye hygiene, keeping your dog at a healthy weight, and being alert to early changes in breathing, energy, or behaviour all go a long way. Most of what affects Shih Tzus is manageable when caught early, and many conditions are preventable with the right daily habits in place.
Every Shih Tzu is different. If you want to know exactly what your dog needs based on their age, weight, and lifestyle, the Hero Health Assessment gives you a personalised recommendation in under two minutes.
