10-month-old baby's bloodshot eye turned out to be rare form of cancer

Nuala Mulholland, from Liverpool, was diagnosed with a soft tissue tumour affecting about six people in England per year when she was just 10 months old. Her mother, Megan Mulholland, first noticed something was wrong with her daughter’s eye in 2023 when it became bloodshot.

Initially thought to be a subconjunctival haemorrhage, a usually harmless condition where a tiny blood vessel breaks underneath the eye's clear surface, the situation worsened as the eye started to bulge. Megan took Nuala to the hospital, and days later, they received the devastating news that she had cancer.

Speaking to PA, Megan said: "It was just horrendous. When I took her to A&E, I still didn’t think it was something as serious as cancer. When they called to say after her MRI it was a tumour, it was devastating."

The now one-year-old, who has a big brother Jack, nine, had her eye removed and was given the all-clear in January. Her surgeon, Ankur Raj, a consultant in paediatric ophthalmology at Alder Hey, collaborated with the prosthetics team at Aintree University Hospital to create her prosthetic eye using a novel method.

Patients typically undergo a lengthy process involving a wax mould of the eye socket, followed by a silicone mould. Mr Raj explained to PA: "You need to sit there for hours – you’re not going to get that with a one-year-old."

Instead, the team used MRI scans, CT scans, and photographs to reconstruct her face. The MRI and CT images shaped the prosthetic, while photographs matched its position to her other eye. Colour matching to Nuala’s skin was done in person.

This method meant Nuala did not need anesthesia for the mould. Mrs Mulholland said: "She’s been put to sleep about 15 times now, so it was a relief to us.

Nuala had her first fitting for the prosthetic eye in June, with specialists currently working on further colour matching. Another fitting is expected in August. The family has been advised to have Nuala wear the prosthetic for a few hours daily to get used to it, and the team is working on a version for longer wear.

Taran Malhotra, lead reconstructive scientist and specialist maxillofacial prosthetist at Aintree University Hospital, said: "Creating a prosthetic eye for Nuala was a unique experience. In the future, she can have orbital implants placed into her bone, providing better retention and eliminating the need for any adhesive." As Nuala grows, the team will continue to create progressively larger prosthetics.

Mrs Mulholland praised the medical team's efforts and her daughter’s resilience, stating, "Like everything she’s just adapted so well. She takes a lot of it in her stride. She’s been really, really resilient – that’s what’s helped us get through. Three days after one of her operations, we were in soft play."

Nuala’s case was a first for Mr Raj and many of his colleagues at Alder Hey’s ophthalmology department. Alveolar soft part sarcoma, one of the rarest types of sarcomas, usually affects the arms and legs. According to Sarcoma UK, there are an average of six cases diagnosed in England each year.

Mrs Mulholland recalled the extensive consultations between Alder Hey and other hospitals once they identified the sarcoma. "Once we’d established it was alveolar soft part sarcoma, they told us it didn’t respond to chemo, and the only way to cure her would be to remove the eye." The family was also offered radiotherapy but decided against it due to its potential lifelong impact on Nuala.

Mr Raj explained: "Radiotherapy can be quite a destructive process, especially for children. Not only can it damage the eye, it causes the orbit to not grow equally to the other side. The risk then is that that side of the face doesn’t grow properly, which is difficult to correct in the future."

Mrs Mulholland added: "Basically, for us, we felt like we had to make a good decision from two bad choices – radiotherapy or removing the eye. It felt like a rock and a hard place. We had to make the best decision for her."

Mrs Mulholland shared that she has become accustomed to people noticing Nuala and welcomes their questions. "My husband’s always been brilliant, but I’ve felt vulnerable," she told PA.

She added: "I’ve had to build up to taking her out without her eye patch. I could see people looking and then looking away, like they hadn’t seen her, rather than engaging with her like you would any baby. A lot of the time, there are children asking, and I don’t mind at all – I’m happy to share her story. It’s better to ask what’s happened and take a general interest."

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Nuala has now learned to walk and has started nursery. "She’s had some problems with learning to walk, but she’s mastered it now. In general, she’s come on lovely. She’s doing everything you’d expect a 20-month-old to do," said Mrs Mulholland.

Mr Raj added that Nuala has been "fantastic at getting things done." "She just let us get on with it. She’s been phenomenal. The family as a whole have just been brilliant."