Child whose eye was injected with aggressive cancer gets ‘amazing’ prosthetic eye after losing his vision

A girl whose eye was injected with cancer has received a new form of prosthetic eye.

20-month-old Nuala Mulholland’s prosthetic from Liverpool is just a little bigger than a pound coin.

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The manufacturing process also meant that the child did not need to undergo anesthesia, which was a “relief” for parents Megan Mulholland, 36, and Richard Mulholland, 39.

Nuala was diagnosed with a soft tissue tumor that affects around six people in England every year when she was 10 months old.

Megan first noticed something wasn’t right with her daughter’s eye in 2023 when it turned red.

Nuala was initially thought to have subconjunctival hemorrhage, a generally harmless condition in which a small blood vessel ruptures beneath the clear surface of the eye.

But when the eye began to bulge slightly, Megan took her daughter to hospital and days later the family were told she had cancer.

“It was horrible,” Megan said. “When I took her to the emergency room, I still didn’t think it was something as serious as cancer.

“When they called to say after the MRI it was a tumor, it was devastating.”

Nuala, who has an older brother Jack, nine, ended up having her eye removed and was released in January.

Doctors used a new method to design and manufacture his prosthetic eye, which was less invasive than traditional methods due to his age.

Nuala surgeon Ankur Raj, consultant in pediatric ophthalmology at Alder Hey, worked with the prosthetics team at Aintree University Hospital.

Patients who require this type of prosthesis usually face a long process of removing a wax mold from the eye socket, which is then transformed into a silicone mold.

Raj said: “You need to sit there for hours – you won’t do that with a one-year-old.”

In Nuala’s case, the team did a series of MRI scans, CT scans and photographs to help them reconstruct her face.

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MRI and CT images were used to shape the prosthesis, while photographs were used to match it to the position of the other eye.

Color matching to Nuala’s skin was then carried out in person.

The process also meant that Nuala would not need anesthetic for the cast.

“She’s been put to sleep about 15 times already, so it’s been a relief for us,” Megan said.

NEW EYES AS SHE AGES

Nuala had her first fitting for the prosthetic eye in June, and experts are now working further on color matching.

Another test is scheduled to take place in August.

The family advised Nuala to wear the prosthetic for a few hours a day so she could get used to it.

The team is also currently working on a longer-use version, Megan said.

Taran Malhotra, lead reconstructive scientist and maxillofacial prosthetics specialist at Aintree University Hospital, said: “Creating a prosthetic eye for Nuala was a unique experience.

“In the future, she will be able to place orbital implants in her bone providing better retention, eliminating the need for any adhesive.”

As Nuala grows, the team will continue to create larger and larger prosthetics.

Megan said it was “amazing” what they had managed to achieve and praised the way her daughter had embraced her new prosthetic.

“Like everything, she adapted really well,” she said. “She takes it very calmly.

“She’s been very, very resilient – ​​that’s what got us through. Three days after one of her operations, we were in a calm situation.”

Nuala’s case was the first in the career of Raj and many of his colleagues at Alder Hey’s ophthalmology department.

THE RISK FACE DOES NOT GROW PROPERLY

Alveolar soft tissue sarcoma is one of the rarest types of sarcomas. It can happen anywhere on the body, but usually affects the arms and legs.

According to Sarcoma UKThere are an average of six cases of alveolar soft tissue sarcoma diagnosed in England each year.

Mrs Mulholland said: “There have been many conversations between Alder Hey and many other hospitals across the country.

“Once we established it was alveolar soft tissue sarcoma, they told us it didn’t respond to chemotherapy and the only way to cure it was to remove the eye.”

Nuala’s parents were also given the option of radiotherapy, but this could have a lifelong impact on their daughter due to her age.

Raj said radiotherapy can be “a very destructive process, especially for children”, adding: “Not only can it damage the eye, it causes the orbit not to grow equally to the other side.

Megan said: “Basically, for us, we felt we had to make a good decision between 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.”

Megan said she has had to get used to people noticing Nuala, but welcomes people who ask questions.

“My husband was always brilliant, but I felt vulnerable,” she said. “I had to prepare myself to go out with her without the eye patch.

“I could see people looking and then looking away, as if they hadn’t seen her, instead of engaging with her like they would with any baby.

“There are often kids asking and I don’t mind at all – I’m happy to share her story. It’s better to ask what happened and have general interest.”

Nuala has now learned to walk and started daycare.

Megan said: “She had some trouble learning to walk, but she has mastered it now.

“Overall, she’s adorable. She’s doing everything you’d expect a 20-month-old to do.”

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 has been brilliant.”

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