Managing Dry Eye in Shih Tzus: Symptoms to Treatments

Dry eye (keratoconjunctivitis sicca, KCS) is a common, potentially sight-threatening condition in older Shih Tzus. Because Shih Tzus are a [brachycephalic](https://seniorpet.org/knowledge/persian-cat-brachycephalic-airway "Brachycephalic Syndrome Guide"), long-coated toy breed with prominent eyes and frequent facial hair contact with the ocular surface, they have specific risk factors, presentations, and treatment considerations that differ from many other breeds. This article, aimed at the educated pet owner of a senior [Shih Tzu](https://seniorpet.org/knowledge/breed/shih-tzu "Senior Shih Tzu Health Guide") (9–10 years; typical lifespan 10–16 years), explains how to recognize KCS, how veterinarians diagnose and treat it, how it overlaps with other breed‑specific problems (proptosis, [progressive retinal atrophy](https://seniorpet.org/knowledge/siamese-cat-progressive-retinal-atrophy "Progressive Retinal Atrophy Guide"), periodontal and kidney disease, brachycephalic airway syndrome, and intervertebral disc disease), and what actionable steps you can take at home and with your veterinarian to protect your dog’s vision and comfort.

Why Shih Tzus are at special risk

Several breed-specific features increase KCS risk and complicate management in Shih Tzus:

• Brachycephalic conformation: Shallow orbits and prominent globes predispose to exposure keratitis and corneal drying; eyelid conformation and facial folds may cause irritation, trichiasis (hair rubbing on the cornea), or medial entropion, all of which can disturb the tear film.
• Heavy periocular hair: Facial coat and eyelashes commonly touch the cornea, promoting chronic irritation and secondary inflammation.
• Immune-mediated lacrimal gland disease: Like many small breeds, Shih Tzus can develop immune-mediated lacrimal gland dysfunction causing decreased tear production.
• Age-related change: Tear production commonly decreases with age; seniors (9–10 years and up) should be screened more often.
• Surgical/anesthetic risk: Many corrective and advanced procedures (parotid duct transposition, tarsorrhaphy) require anesthesia — which is riskier in brachycephalics and dogs with IVDD or kidney disease.

What is dry eye (KCS)?

KCS is inadequate production of the aqueous component of the tear film and/or excessive tear evaporation that results in ocular surface inflammation, mucus accumulation, corneal ulceration, scarring, pigmentation, and vision loss if untreated. In Shih Tzus, KCS often has a mixed pattern: true aqueous deficiency (low Schirmer Tear Test values) combined with evaporative loss from exposure, trichiasis, or facial folds.

Recognizing symptoms in an older Shih Tzu

Shih Tzu owners should watch for subtle and breed‑specific signs:

• Sticky, mucoid, often yellowish discharge rather than clear watery tears
• Chronic red or inflamed eyelids and conjunctiva
• Frequent squinting, blinking, or pawing at the face
• Dull, cloudy, or bluish cornea (early signs of corneal scarring or pigment)
• Increased tear staining along the facial folds and muzzle
• Recurrent corneal ulcers or infections
• Behavioral changes such as decreased activity or reluctance to go outdoors at night (if vision is impacted)

Because Shih Tzus often have naturally prominent eyes, small changes (e.g., less brightness of the cornea, increased mucoid discharge) may be the earliest clues.

Diagnosis: what your veterinarian will do

A veterinary ophthalmology exam for suspected KCS commonly includes:

• Schirmer Tear Test (STT I): a paper strip placed at the lateral lower eyelid to measure mm of wetting in 60 seconds. Typical values and interpretation:

| STT (mm/min) | Interpretation | Immediate action | |--------------|----------------|------------------| | >15 mm/min | Normal | If clinical signs present, investigate evaporative causes (trichiasis, exposure) | | 10–15 mm/min | Borderline | Close monitoring; consider treatment if signs present | | 5–10 mm/min | Mild–moderate KCS | Start medical therapy (tear stimulants and lubrication) | | <5 mm/min | Severe KCS | Urgent treatment to prevent ulcers/scarring |

• Ocular surface staining (fluorescein) to detect corneal ulcers
• Slit‑lamp exam to assess corneal health, tear film break-up time, and eyelid conformation
• Cytology/culture if infection is suspected
• Neurologic assessment if neurogenic KCS is considered

Note: Because Shih Tzus often have mixed evaporative problems, your vet may also evaluate eyelid conformation (entropion/ectropion), hair contact, and facial folds.

Medical treatments: evidence-based options

Veterinary clinical studies and consensus guidelines (see Veterinary Ophthalmology and JAVMA literature) support a tiered approach: restore lubrication, suppress immune-mediated lacrimal inflammation, treat infection or ulceration, and address mechanical/evaporative causes.

First-line (foundation) therapy — lubrication and ocular hygiene

• Frequent preservative‑free artificial tear drops during the day (q4–8 hours) and ophthalmic gels/ointments at night to protect the cornea.
• Choose products formulated for dogs; hyaluronic acid–containing lubricants often provide longer-lasting relief and improved comfort.
• Gently clean mucoid discharge with saline and cotton or soft tissue; keep facial hair clipped away from the eye.

Actionable tip: For an older Shih Tzu, aim for 3–6 lubricant applications daily initially; increase if activity or environment (air conditioning/heating) promotes dryness.

Immunomodulatory lacrimostimulants — cyclosporine and tacrolimus

• Topical cyclosporine A (commercially available 0.2% ointment, e.g., Optimmune) is a well‑established treatment that increases tear production and controls ocular surface inflammation in many dogs. Studies and clinical experience show measurable improvement in STT values and reduced corneal inflammation with chronic use (Veterinary Ophthalmology; JAVMA reports).
• Tacrolimus (0.02% ophthalmic drops or compounded formulations) is often used when cyclosporine is insufficient; several clinical reports indicate a higher or faster response rate with tacrolimus in dogs refractory to cyclosporine (Veterinary Ophthalmology literature).

Typical patterns (discuss with your veterinarian):

• Cyclosporine ointment: commonly prescribed twice daily long-term; some dogs require once daily maintenance once controlled.
• Tacrolimus drops: often started q12h or q8h and may be tapered based on response.

Practical note: Both drugs are immunomodulatory (not topical steroids) and are safe with minimal systemic absorption. They are appropriate for long-term use, but require owner commitment to chronic therapy.

Adjunctive therapies

• Topical antibiotics: indicated if secondary bacterial infection or corneal ulcer is present.
• Systemic parasympathomimetics (e.g., oral pilocarpine) are used rarely and only under specialist supervision because of systemic side effects; they are not first-line in older Shih Tzus, especially those with cardiac, respiratory, or kidney disease.
• Short-term topical anti‑inflammatory therapy (non‑steroidal ophthalmic agents) may be used with caution under specialist advice if inflammation persists and the cornea is intact.

Surgical options when medical management fails

If adequate tear production cannot be achieved or corneal damage progresses, veterinary ophthalmologists may recommend:

• Parotid duct transposition (PDT): reroutes salivary flow to the conjunctival sac to lubricate the eye. PDT can restore surface moisture and comfort but produces saliva (mucous) that differs from natural tears and requires ongoing care. Success rates in refractory KCS are substantial, but complications include duct obstruction, infection, and mucous accumulation; careful selection and owner counseling are essential.
• Permanent or temporary lateral tarsorrhaphy (partial eyelid sewing) to reduce exposure while the cornea heals.
• Eyelid surgery to correct entropion, remove trichiasis, or revise facial folds that cause exposure.

Important breed-specific note: Because Shih Tzus are brachycephalic and many have concurrent BOAS (brachycephalic obstructive airway syndrome), any anesthetic/surgical plan must involve careful pre‑operative airway assessment, possible pre‑oxygenation, and intra‑operative airway protection. Discuss anesthetic risk with your veterinarian and consider having an experienced anesthetist or specialist team involved.

Managing concurrent breed-related conditions

KCS rarely exists in isolation in senior Shih Tzus. Common comorbidities influence diagnosis, treatment choices, and prognosis.

• Proptosis: Shallow orbits increase the risk of globe prolapse with trauma. A proptosed eye is an emergency; corneal exposure can exacerbate KCS. After emergency management, long-term tear management is critical.
• Progressive Retinal Atrophy (PRA): PRA is reported in Shih Tzus; it causes night blindness progressing to vision loss. KCS affects the cornea and surface but PRA affects the retina; both can coexist—regular ophthalmic exams help differentiate causes of visual change.
• Periodontal disease: Chronic oral infections can increase systemic inflammation. While not a direct cause of KCS, severe periodontal disease complicates anesthesia for surgical options and can be a source of general health decline. Maintain dental care and pre-op dental evaluation.
• Kidney disease: Common in older small-breed dogs and alters drug choices and anesthetic risk. Systemic immunosuppressants should be avoided; topical cyclosporine/tacrolimus have minimal systemic absorption and are preferred. Always inform your vet about kidney disease.
• Intervertebral disc disease (IVDD): IVDD limits mobility and increases anesthesia/sedation risk. For dogs with IVDD, plan for minimal-risk anesthetic protocols and discuss local/regional/regimen alternatives.

Practical, actionable owner guidance

Screening and home monitoring

- For senior Shih Tzus (9–10 years+), ask your veterinarian for baseline STT and ophthalmic exam annually or sooner if signs appear. - Keep a daily diary: note discharge type/color, blinking frequency, squinting, and behavior changes. Take photos/videos to show your vet.

Medication administration tips

- Warm ointments/drops in your hands before application for comfort. - Use a calm positive-reinforcement approach; small treats after application help compliance. - Avoid touching the dropper/ointment tip to the eye; clean tip if it touches fur or discharge. - For ointments: place a small ribbon into the lower conjunctival sac; expect temporary blurred vision. - For drops: gently pull down lower eyelid, instill one drop, then close the eye to help spread the medication.

Grooming and mechanical management

- Keep periocular hair trimmed to prevent trichiasis. - Clean facial folds gently with saline daily; drying the area prevents trapping of discharge. - Use an Elizabethan (E‑collar) if your dog rubs at the eye while a corneal ulcer or active treatment is underway.

Lifestyle/environment

- Reduce environmental drying: avoid direct air blowers, prolonged heater or AC exposure, and smoky or dusty areas. - Omega‑3 fatty acid supplementation may support ocular surface health; discuss an appropriate veterinary formulation and dose. - Maintain dental health to reduce systemic inflammation and anesthetic risk.

When to seek emergency care

- Sudden eye protrusion (proptosis), intense pain (continuous pawing, yelping), sudden cloudiness or bleeding, or signs of systemic illness (lethargy, anorexia) require immediate veterinary attention.

Long-term prognosis and follow-up

• With early detection and consistent medical therapy (topical cyclosporine or tacrolimus plus lubricants), many Shih Tzus regain tear production and maintain comfortable eyes for years. Long-term therapy is often required, and owners should expect lifelong medication in many cases.
• Failure to treat or poor compliance commonly leads to progressive corneal scarring, pigmentation, decreased vision, and chronic pain.
• If medical therapy is inadequate, surgical options like PDT can restore ocular comfort but require specialized surgical expertise and careful postoperative care.

Special considerations for anesthesia and surgery

Because many senior Shih Tzus will have BOAS, periodontal disease, and possible kidney disease, pre-surgical planning is essential:

• Preoperative bloodwork (CBC, chemistry panel, renal values) and an airway assessment are mandatory.
• Shorter anesthesia times and experienced anesthetic monitoring reduce risk.
• Discuss staged procedures (e.g., airway correction before elective ocular surgery) as needed.

Veterinary research and evidence base

• Numerous publications in Veterinary Ophthalmology and the Journal of the American Veterinary Medical Association support the efficacy of topical cyclosporine A for immune-mediated KCS and demonstrate improvement in STT and corneal health in treated dogs.
• Comparative studies and clinical reports indicate topical tacrolimus can be effective in cyclosporine-refractory cases and may produce faster lacrimal improvement in some patients (Veterinary Ophthalmology case series).
• Parotid duct transposition is an established surgical salvage option for refractory KCS, with multiple case series documenting improved comfort and vision where medical therapy failed (JAVMA; Veterinary Ophthalmology literature).
• Evidence supports that brachycephalic breeds (including Shih Tzus) have higher rates of ocular surface disease due to conformation-related exposure and trichiasis; addressing mechanical causes improves outcomes (breed-conformation studies, veterinary ophthalmology reviews).

Ask your veterinarian or a board‑certified veterinary ophthalmologist for copies of relevant peer‑reviewed studies if you want primary literature to read.

Final checklist for the Shih Tzu owner

• Watch for mucoid discharge, squinting, or corneal cloudiness.
• Request STT during senior wellness exams or when eye signs first appear.
• Start or continue prescribed immunomodulatory drops (cyclosporine/tacrolimus) and consistent lubricant therapy.
• Keep facial hair trimmed and clean facial folds daily.
• Optimize dental and overall health before elective ocular surgery.
• Coordinate with your vet regarding anesthesia risk if surgery is recommended.
• Maintain regular follow-up with ophthalmic reassessment and STT monitoring (every 3–6 months initially, then as advised).

Managing dry eye in a senior Shih Tzu is a long-term, often manageable commitment. With early detection, appropriate immunomodulatory therapy, diligent [home care](https://seniorpet.org/knowledge/pillar/home-care-guide "Senior Pet Home Care Guide"), and coordination with your veterinarian (and a veterinary ophthalmologist when necessary), affected Shih Tzus can remain comfortable, retain vision, and enjoy a good [quality of life](https://seniorpet.org/knowledge/siamese-cat-quality-of-life "Quality of Life Assessment") into their senior years.

If you suspect your Shih Tzu has dry eye, schedule a veterinary ophthalmic evaluation — early intervention preserves comfort and sight.