Nuala Mulholland: The 20-month-old who had her eye removed and replaced with a prosthetic after being diagnosed with a rare form of cancer

Megan Mulholland knew something was "wrong" with her daughter Nuala when she looked at the toddler's "bloodshot" eyes

A mum knew that her 10-month-old daughter's life was in danger before she was diagnosed with a deadly disease.

Megan Mulholland new that something was "not right" with her daughter when she noticed Nuala's "bloodshot" eyes. The toddler's parents' worst nightmare came true when they were told by the doctors that their daughter had Alveolar soft part sarcoma (ASPS) - an extremely "rare form of cancer".

The mother initially thought that her daughter had subconjunctival haemorrhage, a usually harmless condition where a tiny blood vessel breaks underneath the clear surface of the eye. But Nuala's eyes started to bulge slightly and Megan took her to a consultant where the parents were later told that their daughter had a rare form of the disease.

Later on, doctors employed a novel method to design a prosthetic eye for Nuala, slightly larger than a pound coin in size. This approach meant the 20-month-old toddler did not have to undergo anaesthesia, much to the relief of her parents, Megan and Richard Mulholland. Nuala, who has a big brother named Jack, aged nine, eventually had her eye removed and was given the all-clear in January. Due to her young age, doctors chose this innovative and less invasive technique to create her prosthetic eye.

Mrs Mulholland said: "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. It was just horrendous." Ankur Raj, a consultant in paediatric ophthalmology at Alder Hey, collaborated with the prosthetics team at Aintree University Hospital on Nuala's surgery. Patients who require this type of prosthetic usually face a lengthy process of having a wax mould taken off the eye socket, which is then turned into a silicone mould.

Mr Raj said: "You need to sit there for hours, you’re not going to get that with a one-year-old." In Nuala’s case, the team took a series of MRI scans, CT scans and photographs to help them reconstruct her face. The MRI and CT images were used to shape the prosthetic, while photographs were used to match it to the position of the other eye. Nuala's skin colour was matched to the prosthetic, and the process also meant that she wouldn't have to have an anaesthetic for the mould.

Megan 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, and specialists are now doing further work on colour matching. Another fitting is expected to take place in August.

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, eliminating the need for any adhesive."

The family was advised that Nuala would have to wear the prosthetic for a couple of hours each so she could get used to it. The team are also currently working on a version for longer wear and will continue to create progressively larger prosthetics as she grows.

Megan said what the doctors have been able to achieve is "amazing" and praised the way her daughter has taken to her new prosthetic. She said: "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 Ankur Raj's career's first and many of his colleagues at Alder Hey's ophthalmology department. Megan said that "there were a lot of conversations between Alder Hey and a lot of other hospitals around the country." Richard and Megan were also given an option for radiotherapy but it could be a "destructive process' rather than constructive, and also could have a lifelong impact on Nuala's body due to her age.

Ankur said radiotherapy can be "quite a destructive process, especially for children", adding: "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."

Megan said: "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. She also expressed how she has had to get used to people noticing Nuala but welcomes if people ask questions out of curiosity.

"My husband’s always been brilliant but I’ve felt vulnerable. I’ve had to build

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