At just 10 months old, Nuala Mulholland from Liverpool was diagnosed with an extremely rare cancer known as alveolar soft part sarcoma. The tumour had developed behind her left eye.

Her mother, Megan, first noticed that Nuala’s eye had become increasingly bloodshot. After an urgent MRI confirmed a tumour, doctors determined that the cancer did not respond to chemotherapy. The only way to save her life was to surgically remove the affected eye. The enucleation took place shortly after Nuala’s first birthday.

In January 2024, Nuala was declared cancer-free. Specialists at Alder Hey Children’s Hospital then faced the challenge of creating a prosthetic eye for such a young patient. Traditional methods require lengthy wax moulds of the eye socket while the child remains still — a process impossible for a toddler without repeated general anaesthesia.

Instead, a pioneering non-invasive approach was used. The team combined MRI and CT scans from Alder Hey with advanced 3D imaging and photography at Aintree University Hospital’s prosthetics service. This allowed them to design a custom prosthetic the size of a £1 coin that matched the position, shape and colour of Nuala’s remaining eye, without the need for traumatic moulds.

Nuala adapted quickly to her new prosthetic. Her parents describe her as remarkably resilient, continuing to play and engage with life as any other toddler would.

The family has since partnered with Sarcoma UK to raise awareness of this rare cancer, which affects only about six people in England each year. They hope to help both parents and clinicians recognise unusual eye symptoms early so that other children can receive prompt diagnosis and treatment.

Nuala’s case marks an important step forward in paediatric ocular prosthetics and stands as a powerful example of medical innovation combined with a child’s extraordinary strength.

Sources

• BBC News, Alder Hey Children’s Hospital Trust, Metro, Sky News and The Independent reports (July 2024)
• Statements from Nuala’s parents Megan and Richard Mulholland and consultant Mr Ankur Raj