Clinical Reasoning in Veterinary Ophthalmology: A Pathophysiology-Centered Framework for Canine and Feline Clinical Practice

Clinical reasoning enables veterinarians to make clinical decisions for individual patients by integrating clinical information with scientific evidence, knowledge of underlying disease processes, and case-specific circumstances. This review aimed to clarify clinical reasoning in canine and feline ophthalmology, with particular emphasis on pathophysiological interpretation, and to organize major theoretical frameworks of clinical reasoning in relation to the ophthalmic diagnostic process. A narrative and conceptual review was conducted using PubMed and Google Scholar, with literature searched from February 2026 through 31 August 2026. Relevant publications were selected according to their conceptual contribution to clinical reasoning, cognition, decision-making, clinical practice, or clinical education rather than predefined systematic-review eligibility criteria. Fifteen theoretical frameworks were organized into four groups according to their primary theoretical roles: historical and normative theories of reasoning; foundational theories of modern cognitive science; theories of clinical reasoning and decision-making; and theories of clinical education and expertise. The framework was illustrated through three representative clinical scenarios involving glaucoma in a Shiba Inu, a descemetocele with aqueous humor leakage in a Japanese cat, and traumatic proptosis in a Chihuahua. The analysis demonstrates how different theoretical perspectives can contribute to the interpretation of clinical information and its connection to pathophysiological understanding and clinical decision-making. PCCR is proposed as an integrative clinical reasoning framework that places pathophysiological interpretation between clinical information and patient-specific decision-making. Its applicability beyond veterinary ophthalmology remains a conceptual proposition requiring future evaluation.