Chronic intranasal xylazine use resulting in nasal, palatal, and orbital floor necrosis with inferior rectus entrapment

Suwanee, GA

Xylazine, a non-opioid veterinary tranquilizer not approved for human use, has infiltrated the illicit drug supply causing public health officials to release statements warning of an emerging epidemic. Referred to as “Tranq” or “Tranq-Dope” when combined with heroin or fentanyl, recreational xylazine in the United States was first detected in Philadelphia in 2006, and has been associated with increasing fatal overdoses and chronic necrotic wounds. Xylazine functions as a strong synthetic alpha-2-adrenergic agonist but is thought to have partial alpha-1-adrenergic agonist activity, inducing peripheral vasoconstriction, poor perfusion, and necrosis. Numerous case reports and media photos have emerged of “characteristic necrotic skin ulcers” resulting from xylazine injection. However, little has been reported on the physical consequences of intranasal Xylazine usage. To our best knowledge, we present the first case that highlights complications of intranasal xylazine inhalation as well as the first report of inferior rectus entrapment resulting from intranasal drug usage.