When Megan Mulholland first noticed that her nine-month-old daughter Nuala had a bloodshot eye, she had no reason to believe it could be a sign of cancer.

At first, the unusual redness was thought to be a subconjunctival haemorrhage — a generally harmless condition caused by a small blood vessel breaking beneath the surface of the eye. But the appearance of Nuala’s eye soon began to change. It became more prominent and was pushed forward and to the side.

Megan took her daughter to A&E, where further tests and an MRI revealed something far more serious: a tumour growing behind Nuala’s left eye.

Nuala was only 10 months old.

Doctors at Alder Hey Children’s Hospital in Liverpool diagnosed her with alveolar soft part sarcoma (ASPS), an exceptionally rare form of soft-tissue cancer. The hospital says the disease affects only around six people in England each year. In Nuala’s case, doctors had never previously encountered the tumour in that particular location around the eye.

A Rare Cancer Behind Her Eye

The tumour was growing in one of the muscles surrounding Nuala’s eye. As it increased in size, it gradually pushed her eye forward and sideways.

Doctors initially attempted to remove the tumour while preserving Nuala’s eye. However, laboratory testing showed that cancer cells remained at the edge of the removed tissue.

That left Nuala’s parents facing an agonising decision.

One option was radiotherapy. But because Nuala was so young, specialists warned that radiation could damage the developing tissues around her eye and potentially prevent that side of her face from growing normally.

The alternative was much more drastic: removing the eye and surrounding tissues.

For Megan and her husband Richard, neither option was easy. But they believed surgery offered their daughter the best chance of preventing the cancer from progressing. Nuala ultimately underwent further surgery to remove her left eye.

A Baby Facing an Extraordinary Medical Journey

Nuala underwent three surgeries during her treatment and had numerous hospital appointments, MRI scans and X-rays.

Her family also had to adjust to the reality that their daughter would grow up with sight in only one eye.

Despite everything, Nuala continued to show remarkable resilience.

Her mother said that Nuala adapted surprisingly well to the changes. She needed an eye patch and took longer than expected to learn to walk, but she eventually started nursery, made friends and continued developing as a happy young child.

In January 2024, Nuala reached an important milestone when she was able to ring the hospital’s end-of-treatment bell.

For her family, it was a moment of enormous relief and celebration after months of uncertainty.

An Unusual Challenge: Creating a New Eye

Nuala’s treatment presented doctors with another challenge.

Because she was still a toddler, producing a conventional prosthetic eye would have been difficult. Traditionally, specialists can make an impression or mould of the eye socket and use it to create a customised prosthesis. For a very young child, however, this process can be invasive and difficult to perform safely and comfortably.

Alder Hey therefore worked with specialists at Aintree University Hospital to find another solution.

Instead of making a physical mould of Nuala’s eye socket, the team used MRI and CT scans, together with photographs, to digitally reconstruct the shape and dimensions needed for her prosthetic eye.

The approach allowed specialists to create a customised prosthesis while minimising physical contact with the young child.

The prosthetic was first fitted in June 2024, when Nuala was around 19 months old. Specialists planned to continue refining the prosthesis and producing larger versions as she grows. In the future, doctors said orbital implants could potentially provide improved retention and reduce the need for adhesive.

“She Amazes Us Every Day”

For Nuala’s mother, the entire experience has been an emotional journey.

Megan described finding out that her baby had cancer as one of the most heartbreaking things a parent could hear. But she also praised the medical teams at Alder Hey and Aintree for supporting the family throughout Nuala’s treatment and recovery.

Nuala’s surgeon, consultant paediatric ophthalmologist Ankur Raj, said her resilience throughout examinations, procedures and treatment had been remarkable.

The specialists involved in creating her prosthetic eye also described the process as an unusual and rewarding experience because of Nuala’s age and the complexity of her case.

The innovative technique demonstrated how modern imaging and 3D planning can provide alternatives when traditional medical procedures are unsuitable for very young patients.

From a Frightening Symptom to a New Beginning

Nuala’s story began with something that could easily have been dismissed as harmless: a bloodshot eye.

But when the eye changed shape and began to bulge, her parents sought further medical attention. That decision ultimately led to the discovery of a rare and potentially life-threatening cancer.

After surgery and treatment, Nuala was able to move forward.

By 20 months old, she was attending nursery, learning to walk and adapting to life with sight in one eye. Her family said she continued to thrive despite the extraordinary challenges she had faced so early in life.

Her case also helped highlight the importance of awareness around rare cancers. Alveolar soft part sarcoma is uncommon and can develop in different soft tissues, making unusual symptoms particularly important to investigate when they persist or change.

Nuala’s journey is ultimately a story about more than cancer.

It is about a family noticing that something was not right, doctors acting quickly, specialists finding an innovative solution and a little girl adapting to circumstances that would challenge even an adult.

A tiny change in Nuala’s eye led to a life-changing diagnosis. But thanks to early investigation, specialist treatment and an innovative prosthetic solution, she was given the opportunity to continue growing, learning and enjoying childhood.

Her story is a powerful reminder that sometimes the smallest warning signs deserve our attention — and that even after an incredibly difficult beginning, there can still be hope for a brighter future.

Sources

• Alder Hey Children’s Hospital — Nuala’s Story: Official account of Nuala’s diagnosis, surgeries, treatment, recovery and prosthetic eye.