Hegab and Al-Mutawa (1996) reported a large Jordanian family in which 2 sisters married to cousins had a total of 3 children (1 male and 2 females) with congenital alacrima (but no achalasia). The lacrimal glands were present, ... Hegab and Al-Mutawa (1996) reported a large Jordanian family in which 2 sisters married to cousins had a total of 3 children (1 male and 2 females) with congenital alacrima (but no achalasia). The lacrimal glands were present, the lacrimal puncta were patent and apparently normal, but no tear production could be elicited with tensilon or neostigmine.