When Nuala Mulholland was ten months old, her mother Megan noticed a bloodshot left eye. Doctors first called it a harmless broken vessel under the conjunctiva. Then the eye began to bulge. An MRI at Alder Hey Children’s Hospital in Liverpool showed a tumour behind the globe. The diagnosis was alveolar soft part sarcoma — a rare soft-tissue cancer that appears in about six people a year in England, usually in an arm or a leg, almost never behind a baby’s eye.

The tumour did not respond to chemotherapy. Radiotherapy was offered, but at her age it risked lifelong damage. The only reliable cure was to take the eye. Nuala underwent several operations; the last removed the left eye to stop the cancer spreading. In January 2024 she rang the end-of-treatment bell and was declared clear. The family celebrated with a trip to Wales.

What remained was an empty socket in a toddler too small for the usual prosthetic method: a wax impression of the socket, made under anaesthetic, then cast in silicone. Nuala had already been anaesthetised about fifteen times. Consultant paediatric ophthalmologist Ankur Raj worked with the maxillofacial prosthetics team at Aintree University Hospital. They used MRI and CT scans from Alder Hey, photographs of her face and 3D planning software to build a shell without pressing moulds into the wound. Colour matching was done in person. The first fitting was in June 2024. The finished piece was a little larger than a one-pound coin.

Megan, 36, and Richard, 39, who also have an older son, Jack, said their daughter adapted as she had to everything else — three days after one operation she was in a soft-play centre. Strangers had looked away from the empty socket; the painted eye let people meet her gaze again. As she grows, larger prostheses will be made the same way. Later, implants in the bone may hold the shell without adhesive.

Alveolar soft part sarcoma is easy to miss because it is rare and its first signs can look ordinary. The family has worked with Sarcoma UK so that a bloodshot or bulging eye in a baby is not waved off as a burst vessel. Nuala’s case is also a small technical first: a custom ocular prosthesis designed from scans instead of a painful mould, so a child who had already given an eye did not have to give another anaesthetic for the replacement.

Sources

BBC News Merseyside report on Nuala Mulholland’s Alder Hey prosthetic, July 2024

Alder Hey Children’s Hospital Trust and University Hospitals of Liverpool Group statements on the Aintree 3D workflow

Sky News, Metro and Liverpool Echo interviews with Megan and Richard Mulholland

Sarcoma UK figures on alveolar soft part sarcoma incidence in England

Alder Hey Children’s Charity follow-up on Nuala as a fundraising ambassador