Shih Tzu pet insurance decisions usually start with dental bills, but this breed’s shallow eye sockets add a second question: how a policy handles an eye that is pushed out of place. This guide covers the evidence, the costs and what six insurers publish.
Picture a Shih Tzu being held still for a nail trim, the kind of hold groomers and vet nurses use every day. The dog twists, pressure lands near the head, and one eye comes forward out of its socket.
This is an illustrative scenario, not a reported case. It reflects a documented risk: the American College of Veterinary Ophthalmologists says proptosis in flat-faced breeds is often triggered by minimal trauma or restraint.
Quick answer
An eye pushed out by an injury is typically handled as an accident claim, depending on the policy’s wording, but none of the six insurer pages we checked names proptosis. Whether you are paid depends on the enrollment date, accident waiting periods, the eye’s history, and whether your plan covers exam fees.
For price, Fetch reports a $30 monthly average across its active Shih Tzu policies in 2025, and Lemonade’s illustrative averages rise from $25 to $30 a month at age 1 to $50 to $55 at age 7. Gum disease, not eye injury, was the most commonly recorded disorder in a large UK study, so compare dental cover too.
Shih Tzu Pet Insurance Starts With the Breed’s Eye Anatomy
A Shih Tzu’s short skull leaves less bone around the eye. Embrace’s veterinary guide to proptosis describes the problem in flat-faced dogs as “shallow orbits, prominent globes, and abnormal eyelid conformation,” which together make it easier for the eye to be displaced.
A 2022 study of 50 Shih Tzus in Veterinary Ophthalmology found that 82% of eyes could not close fully during blinking (lagophthalmos), and every eye examined had medial lower eyelid entropion (the inner lower lid rolling inward) and caruncular trichiasis (hairs at the inner corner of the eye). These features explain why surface eye problems are common in the breed.
Those figures come from the 2024 VetCompass study of Shih Tzus by Dale and colleagues, published in Canine Medicine and Genetics. It drew on 11,082 Shih Tzus among 336,865 dogs under UK primary veterinary care in 2016, and reviewed the records of a random subset of 2,423 in detail.
The 11.9% covers every recorded eye disorder, from ulcers to dry eye. The study mentions globe prolapse only as a known risk for flat-faced breeds and reports no proptosis count. We found no published rate of proptosis specific to Shih Tzus, so any exact figure you see elsewhere should be treated with caution.
What Proptosis Is and Why Flat-Faced Breeds Are Prone
Ocular proptosis means the eyeball has moved forward out of its socket, with the eyelids behind it. The Merck Veterinary Manual says it is most commonly caused by blunt trauma, such as being hit by a car or fighting with another animal, and lists breed as a prognostic factor because brachycephalic dogs are predisposed.
In a deep-set eye, that takes a lot of force. In a flat-faced dog it may not. Clinician’s Brief notes that minimal trauma may cause proptosis in these breeds, often without other injuries to the head or body. The ASPCA names Shih Tzus among the breeds where even mild restraint or play can be enough.
This risk does not come from one gene with a carrier test. It follows from the head shape itself, so we found no DNA test that measures it. The practical steps are gentle handling, a harness instead of a neck collar for a dog that pulls, and an insurance plan in place before an injury happens.
Proptosis: what sets it off and why time matters
Emergency Action Plan if Your Shih Tzu’s Eye Comes Out
- Go to a vet or emergency clinic straight away and call ahead while someone drives. Merck’s owner guide says to take the pet to the veterinarian immediately.
- Keep the eye moist on the way. Clinician’s Brief advises a lubricant or wet gauze during transport, because the exposed surface dries quickly.
- Do not try to push the eye back yourself. Merck’s owner guide describes putting the eye back as surgery, done when the dog is healthy enough for general anesthesia.
- Stop pawing and rubbing by holding the dog gently or using a cone if you have one.
- Let the clinic stabilize your dog first. Emergency care should never wait for a cost discussion or an estimate. Once your dog is stable, ask for an itemized estimate for each treatment option and keep your policy number handy for the claim.
Treatment Choices and Published Costs
Vets choose between putting the eye back and removing it. Replacement usually involves a temporary tarsorrhaphy, where the eyelids are stitched partly closed to protect the eye. Merck says the stitches usually stay for 14 to 21 days, until swelling settles and a brisk blink returns.
Removal, called enucleation, is chosen when the eye is badly damaged or cannot be saved. Clinician’s Brief lists a ruptured globe, extensive bleeding inside the eye and torn eye muscles among the findings that point toward a poorer outlook.
| Item | Published figure | Source and what it covers |
|---|---|---|
| Sick-visit exam fee | $50 to $300 | Fetch: general US range for an exam to diagnose a sick pet, not specific to emergencies |
| Enucleation (eye removal) | $500 to $2,000 | Embrace proptosis guide: typical US cost, undated |
| Globe replacement and temporary tarsorrhaphy | Upwards of $4,000 in some cases | Embrace: includes the attendant costs and follow-up expenses |
| Tarsorrhaphy stitches left in place | Usually 14 to 21 days | Merck Veterinary Manual: time, not cost; rechecks add visits |
| Dry eye treatment, if it develops later | $600 to $1,200 | Lemonade: average treatment cost for KCS in Shih Tzus |
We did not find a dated, itemized US price list for proptosis surgery from a university hospital, so treat these as broad ranges. Emergency clinics often charge more than a regular practice, and the final bill depends on imaging, anesthesia, overnight care and how many rechecks follow.
Saving the eye does not always save sight. Merck’s professional manual says about 25% of dogs recover vision, while its owner guide says vision returns in about half of dogs.
Clinician’s Brief summarizes an older study of 66 dogs: 18 eyes kept vision after repositioning, 26 stayed blind but intact and 18 were removed, which works out to about 27%, 39% and 27% by our arithmetic, and four dogs were euthanized.
Follow-up is part of the cost. Merck lists blindness from optic nerve damage, corneal ulceration, a sunken eye, dry eye and a turned eye among the complications, and Veterinary Ireland Journal says tear tests and artificial tears are often needed for months. Embrace calls long-term follow-up care “a near-certainty” after a proptosed eye.
Is Proptosis an Accident or an Illness for Insurance?
An eye pushed out by a fall, a fight or rough handling is an injury, so it is typically treated as an accident. That is our reading of standard policy structure, not insurer confirmation, and classification depends on each policy’s wording and your vet’s diagnosis. None of the six insurer pages we checked mentions proptosis by name.
Three situations can change the answer. If a tumor behind the eye caused it, the claim is likely to be treated as an illness.
If the same eye was displaced before you enrolled, a repeat is likely to count as pre-existing, and Veterinary Ireland Journal says a medial canthoplasty makes repeat proptosis less likely, which means a repeat is possible without one.
Finally, an accident that happens during a waiting period is not covered, which is why the accident waiting periods in the comparison below matter.
Earlier eye notes can matter too. Embrace treats an injury, illness or abnormality noticed before the policy started as pre-existing, and its FAQ extends this to conditions observed during a waiting period.
Ask an insurer in writing whether past notes about tearing or squinting would affect a later eye claim. Always take your dog to a vet when something looks wrong; your dog’s health comes before any policy consideration.
Follow-up care can run into a new policy year. With an annual deductible, as at Embrace and Healthy Paws, rechecks in the next year need the deductible again. Trupanion instead uses a lifetime deductible per condition, so a related follow-up does not trigger a second one.
Shih Tzu Eye-Emergency Insurance Comparison
The table lists only details published on each insurer’s own pages, checked in October 2026. Terms vary by state, product version and enrollment date, and insurers change them over time, so confirm every row in the sample policy for your state before you buy. Where a page says “most states,” we say so.
Our waiting periods guide explains how these periods work.
| Insurer | Accident waiting period | Exam fees | Other relevant terms |
|---|---|---|---|
| Embrace | None: accidents covered from the effective date; illness 14 days; orthopedic varies by state | Optional add-on, not on all policies | Dental illness up to $1,000 per policy year, subject to deductible and reimbursement rate; availability varies by state |
| Fetch | None: accident cover begins on the effective date; illness 15 days; may vary by state | Sick-visit exam fee reimbursed | 180-day orthopedic exclusion (knee exclusion can be waived with a documented healthy-knee exam; hip exclusion cannot); covers disease and injury in all adult teeth |
| Healthy Paws | 15 days in most states; no accident waiting period in 16 states, including CA, FL, OH, PA and WA | Not covered | Annual deductible; limit options of $5,000, $7,000 or unlimited, and a chosen limit cannot be raised later |
| Lemonade | None listed for accidents; illness 14 days; orthopedic 30 days; terms vary by state | Not in the base policy; Vet Visit Fees add-on | Dental Illness add-on with a $1,000 annual limit; the dental add-on options depend on your state |
| Spot | 14 days in most states; check your state’s policy | Covered when directly related to a covered condition; routine wellness exams excluded | Accident and illness exam fees count toward the annual deductible |
| Trupanion | 5 days for injuries and 30 days for illnesses in most states | Not covered (listed under what is not covered) | Lifetime per-incident deductible; unlimited payouts with no annual, lifetime or per-incident caps |
Sources for each row are linked in the table and listed at the end. Exam-fee wording comes from Embrace’s FAQ, Fetch’s coverage page, Healthy Paws’ FAQ, Lemonade’s add-ons page, Spot’s exam-fee guide and Trupanion’s coverage overview.
Illustrative Bill: How Exam Fees and the Deductible Change Your Cost
This example uses made-up numbers to show the arithmetic. It is not a quote or a typical bill. Assume an accident and illness policy with a $500 annual deductible not yet met, 80% reimbursement and a $5,000 annual limit, and a globe-saving surgery bill of $3,700.
| Step | Plan covers exam fees | Plan excludes exam fees |
|---|---|---|
| Emergency exam ($200) plus two recheck exams ($100 each) | $400 eligible | $0 eligible |
| Anesthesia, surgery, tarsorrhaphy and medication | $3,300 eligible | $3,300 eligible |
| Total eligible | $3,700 | $3,300 |
| Minus $500 deductible | $3,200 | $2,800 |
| Insurer pays 80% | $2,560 | $2,240 |
| You pay of the $3,700 bill | $1,140 | $1,460 |
Same policy, eye removed instead. Take a hypothetical $1,500 bill that includes a $200 exam. With exam fees covered: $1,500 minus $500 is $1,000, and 80% of that is $800 back, so you pay $700. With exam fees excluded: $1,300 minus $500 is $800, and 80% is $640 back, so you pay $860.
This example takes off the deductible first and then applies the reimbursement rate. Some policies work in a different order, so check the worked example in your own policy. A real claim can also be reduced by pre-existing exclusions or an insurer’s own limits.
The Shih Tzu’s Other Main Health Risks
Proptosis is the most dramatic eye risk, but it is not the most common reason Shih Tzus see a vet.
The VetCompass study found a median age at death of 12.7 years in the 85 deaths with a recorded age, and the Kennel Club noted that most of its disorders are fairly common in all dogs. Here are the risks that shape a policy most.
Dental and Gum Disease
Periodontal disease was the single most common disorder in the VetCompass study, recorded in 9.5% of Shih Tzus in a year, and dental problems as a group affected 13.3%. Lemonade lists an average treatment cost of $400 to $1,500 for dental disease in the breed.
Dental cover differs more than almost any other benefit. Embrace covers dental illness up to $1,000 a year and dental accidents up to the annual limit.
Fetch covers disease and injury in all adult teeth and gums. Healthy Paws covers extraction or reconstruction of damaged teeth and lists non-routine dental among covered items, while Lemonade sells dental illness as an add-on.
Routine cleanings are not covered by the base policies we checked. Embrace places them under its optional wellness plan, and Lemonade’s Dental Care add-on includes them where it is offered. Our guide to pet insurance that covers dental compares the wording in more detail.
Corneal Ulcers
A 2017 VetCompass study of corneal ulcers using 2013 records from England found Shih Tzus had about ten times the odds of crossbreds (odds ratio 10.04; 3.45% of Shih Tzus affected); Pugs were at 19.05 and Boxers at 12.12. The odds ratio describes relative odds in that population, not an individual dog’s chance.
VCA Animal Hospitals lists squinting, rubbing the eye, redness and sometimes discharge as signs, and warns that ulcers are painful and can progress to blindness.
The ACVO adds that in flat-faced breeds ulcers can quickly deepen or “melt.” Whether an ulcer counts as an accident or an illness depends on the policy wording and the vet’s records. One caused by a scratch may qualify as an accident, while one linked to the breed’s eye shape may be reviewed as an illness.
Dry Eye (Keratoconjunctivitis Sicca)
Dry eye was recorded in 1.2% of Shih Tzus in the VetCompass study, and VCA lists the Shih Tzu among breeds more likely to develop it. VCA says it “requires lifelong medical care,” usually daily drops. Because the cost repeats every year, it suits a policy with a meaningful annual limit, and it becomes pre-existing if diagnosed before you enroll.
Corneal Pigmentation
In the 2022 study of 50 Shih Tzus, 27% of eyes showed pigment on the cornea. The ACVO describes pigmentary keratitis as a dark film that grows over the cornea from chronic irritation, and names medial canthoplasty, a surgery that shortens the inner eyelid opening, as the gold standard for flat-faced eye problems.
The authors of the 2022 study suggest such surgery could be considered as a preventive measure. Whether an insurer treats a preventive canthoplasty as covered or elective is not stated on the pages we checked, so ask before you book it.
Breathing Problems (BOAS)
A 2026 University of Cambridge study of nearly 900 dogs from 14 flat-faced breeds placed the Shih Tzu in a moderate-risk group, where half to three-quarters of dogs had some degree of brachycephalic obstructive airway syndrome, from mild to severe. The study also found being overweight was a significant risk factor. Read more in the University of Cambridge’s summary.
Overall, the VetCompass team found Shih Tzus much less affected by disorders than French Bulldogs, English Bulldogs and Pugs. For breeds where airway surgery is a bigger issue, see our French Bulldog pet insurance guide and English Bulldog pet insurance guide.
Kneecaps (Patellar Luxation)
Slipping kneecaps are often listed for small breeds, and Lemonade puts treatment at $500 to $2,500. In a 2016 VetCompass study of patellar luxation, though, Shih Tzus had an odds ratio of 1.2 with a confidence interval of 0.7 to 1.9, which is not a clear difference from crossbreds.
Orthopedic waiting rules still matter. Fetch applies a 180-day exclusion to knee conditions, which it can waive if a vet exam in that period documents healthy knees.
Accident-Only or Accident and Illness for a Shih Tzu?
An accident-only plan costs less, but Spot notes such plans typically do not cover illnesses. Embrace’s accident-only plan reimburses 90% up to $5,000 a year with a $100 annual deductible. The table shows how the breed’s main risks fit each type. Our accident-only versus accident and illness guide covers the trade-offs in general.
| Shih Tzu risk | Accident-only plan | Accident and illness plan |
|---|---|---|
| Proptosis from an injury | May qualify as an accident, depending on policy wording | May qualify as an accident, depending on policy wording |
| Corneal ulcer, dry eye, pigmentation | Usually not covered if reviewed as illness; an injury-caused ulcer may qualify as an accident | May be eligible if not pre-existing; classification depends on the policy |
| Dental and gum disease | Illness-related dental generally not covered; injury to teeth may be | Varies widely; check dental limits |
| Breathing problems (BOAS) | Generally not covered | May be eligible if not pre-existing; check exclusions and any breed-specific terms |
| Routine dental cleaning | Not covered | Not covered without an add-on or wellness plan |
For most Shih Tzus, the conditions an accident-only plan leaves out are the ones recorded most often. An accident-only plan can still make sense as a backstop for a dog whose owner can comfortably pay for routine dental and eye treatment.
Shih Tzu Pet Insurance Cost
Fetch reports an average of $30 a month for its Shih Tzu plans, across all policy configurations on active Shih Tzu policies from January 1 to November 1, 2025. That is one insurer’s average, not a market rate.
Lemonade publishes averages for its own Shih Tzu accident and illness policies, based on its policy rates as of October 2025. It calls them illustrative only, and other insurers price differently.
| Shih Tzu’s age | Average monthly premium (Lemonade data) |
|---|---|
| 1 to 2 years | $25 to $30 |
| 3 to 4 years | $30 to $35 |
| 5 years | $35 to $40 |
| 6 years | $40 to $45 |
| 7 years | $50 to $55 |
For context, NAPHIA reports that the average US accident and illness premium for dogs of all breeds was $836 a year in 2025, or about $70 a month by our division. That is an all-breed figure, so a small breed like the Shih Tzu can price below it.
When you compare quotes, keep the age, ZIP code, deductible, reimbursement rate and annual limit the same, and note whether exam fees are included. Our pet insurance cost calculator gives a first estimate.
Questions to Ask an Insurer Before You Buy
- Would an eye pushed out by an injury be handled as an accident, and does that change if a tumor is found?
- Are emergency and recheck exam fees covered, or only with an add-on?
- If follow-up care for an eye injury runs into the next policy year, does a new deductible apply?
- Would past notes about tearing, squinting or prominent eyes affect a later eye claim?
- Is a preventive medial canthoplasty eligible, or treated as elective?
- What is the dental illness limit, and which dental treatments are excluded?
- Does an orthopedic waiting period apply to kneecaps, and can an exam shorten it?
Get the answers in writing or check them against the sample policy, since the policy wording decides a claim. Our pre-existing conditions guide explains how insurers review medical records.
Records to Keep for an Eye Claim
- The itemized invoice, with exam fees shown separately from treatment.
- The vet’s notes describing how the injury happened and what was found.
- Discharge instructions, recheck notes and pharmacy receipts for eye drops.
- Your dog’s full medical history, since insurers may review past records when deciding whether a condition is pre-existing.
- Your policy documents, including the effective date and any add-ons.
Is Shih Tzu Pet Insurance Worth It?
It depends on your savings and your dog. Shih Tzus in the VetCompass study had a median age at death of 12.7 years, so years of dental and eye care can add up, and one eye emergency can reach thousands of dollars.
If a bill of a few thousand dollars would be hard to pay, an accident and illness policy bought early is worth considering.
If you have a dedicated vet fund, a higher deductible or a smaller plan may fit better. Insurance cannot prevent any of these conditions; it only limits your share of covered bills. Our guide on whether pet insurance is worth it sets out the general trade-offs.
The Bottom Line on Shih Tzu Pet Insurance
The breed’s shallow eye sockets make proptosis possible from small knocks or firm handling, but the bigger day-to-day costs come from teeth and the eye surface. A good Shih Tzu policy handles both: clear accident cover with exam fees, and meaningful dental and illness benefits.
Consider enrolling early, because conditions noticed before coverage starts can be treated as pre-existing. Read the dental and exam-fee terms closely, keep emergency details handy, and see a vet promptly whenever something seems wrong. You can compare the breed with others in our breed health risk finder, and read how we research every guide on our About page.
Frequently Asked Questions
It can be, depending on your policy wording. The policy usually must be active and past any accident waiting period, and that eye should have no earlier proptosis on record. None of the six insurer pages we checked names proptosis, so a claim rests on each policy’s accident wording. Exam fees, deductibles and limits also affect your payout.
We found no published Shih Tzu-specific rate. VetCompass recorded eye disorders of all kinds in 11.9% of a random sample of 2,423 UK Shih Tzus in 2016, but that figure covers every eye problem, not proptosis, and the study did not report a proptosis count.
Blunt trauma, such as a car strike or a dog fight, is the most common cause. In flat-faced breeds, the American College of Veterinary Ophthalmologists says proptosis is often triggered by minimal trauma or restraint, and Embrace names certain collars and restraint devices. A tumor behind the eye is a less common cause.
Usually. Embrace puts enucleation at $500 to $2,000 and says globe replacement with temporary tarsorrhaphy can cost upwards of $4,000 in some cases, once follow-up care is included. The right choice depends on the eye’s condition, the chance of vision and your vet’s advice, not cost alone.
Fetch reports a $30 monthly average across its active Shih Tzu policies in 2025. Lemonade’s illustrative averages for its own policies, based on October 2025 rates, rise from $25 to $30 a month at age 1 to $50 to $55 at age 7. Your quote depends on age, ZIP code and the plan you choose.
Corneal ulcers, dry eye (keratoconjunctivitis sicca) and corneal pigmentation are the main ones. VetCompass recorded corneal ulceration in 3.5% of UK Shih Tzus in one year, and an earlier VetCompass study found about ten times the odds seen in crossbreds. VCA lists the Shih Tzu among breeds more likely to develop dry eye.
Sources
- Dale F, Brodbelt DC, West G, Church DB, Lee YH, O’Neill DG (2024), Canine Medicine and Genetics: Demography, common disorders and mortality of Shih Tzu dogs under primary veterinary care in the UK; Royal Veterinary College summary: New research highlights surprisingly good health characteristics in Shih Tzu dogs
- O’Neill DG et al. (2017), Canine Genetics and Epidemiology: Corneal ulcerative disease in dogs under primary veterinary care in England
- O’Neill DG et al. (2016), Canine Genetics and Epidemiology: The epidemiology of patellar luxation in dogs attending primary-care veterinary practices in England
- Sebbag L et al. (2022), Veterinary Ophthalmology: An eye on the Shih Tzu dog: ophthalmic examination findings and ocular surface diagnostics
- University of Cambridge researchers (2026), PLOS One, summarized by the University of Cambridge
- American College of Veterinary Ophthalmologists: Understanding Brachycephalic Ocular Syndrome
- Merck Veterinary Manual: Proptosis in Animals (professional version, reviewed July 2024) and Prolapse of the Eye in Dogs (owner version)
- Clinician’s Brief: Repositioning or Enucleation of the Proptosed Globe
- Veterinary Ireland Journal: Canine ophthalmic emergencies
- ASPCA: Certain Dog Breeds Prone to Losing Eyeballs
- VCA Animal Hospitals: Corneal Ulcers in Dogs, Keratoconjunctivitis Sicca (Dry Eye) in Dogs
- Embrace Pet Insurance: Ocular Proptosis, waiting periods, coverage FAQ, accident-only plan, dental illness coverage, pre-existing conditions
- Fetch: Shih Tzu pet insurance, what Fetch covers, waiting periods
- Healthy Paws: Frequently asked questions, coverage and exclusions
- Lemonade: Pet insurance for Shih Tzus, waiting periods, pet insurance add-ons
- Spot: Accident coverage, exam fee coverage
- Trupanion: How pet insurance works, coverage overview for pet owners (PDF)
- NAPHIA: State of the Industry Report 2026, highlights
The PetCoverToday Editorial Team develops and maintains the guides on this site, checking cost figures, coverage terms, and policy rules against insurers' own published pages and, where relevant, veterinary and industry sources. PetCoverToday is an informational website, not a licensed insurance agency, and does not sell policies. Read more about our editorial approach.