Item: Bozo

Isaac's tears are replaced by a knife that pierces enemies, can travel through obstacles, and can hurt enemies while Isaac is holding it. Holding down the fire button before firing increases its range and power.

Spawns a large orbital familiar that blocks enemy projectiles and deals slight contact damage to enemies.

A trail of blue creep is left behind Isaac, which damages enemies.

Greatly increases the chance to find sacks.

Increases Luck by 1, grants 1 Soul Heart and spawns 2 Keys.

Has a chance of spawning a soul heart or black heart when taking damage. Enemies have a chance to drop a Half Red Heart after being killed.

Tears bounce off walls, enemies, and environmental objects.

Increases Tears by 0.7.

Randomly while firing tears, Isaac will stop firing and turn red, where he will charge and release a lot of 'tears' in one go. In the burst of tears is a kidney stone which deals a lot of damage.

Tears are replaced with laser rings that pierce through enemies and deal damage to enemies within them. Can be charged to increase the size of the ring.

The more distance tears travel, the more damage they will do.

Tears start out massive with high damage, and then shrink down and become weaker over a short range.

Grants a familiar that transforms into another random familiar every 10 seconds.

A familiar fly that moves in a straight line and attaches itself to the first obstacle or wall it comes into contact with in each room. If any enemies walk into its path, it will deal 7 contact damage per tick. If the obstacle it is attached to is destroyed then it will continue rolling in the direction it was previously travelling until it meets another wall or obstacle.

Isaac is followed by a small blue cross that will drop a Soul Heart every 4 rooms.

Spawns a familiar that follows Isaac around and fires two tears at once in a V-pattern.

Combined with Key Piece 1, unlocks the golden gate in the starting room of The Chest and Dark Room to fight Mega Satan.

Sets your key count to the maximum of 99.

Whenever a Devil or Angel Room would spawn after defeating a boss, both rooms spawn. Only one can be entered.

Isaac's tears split in two when they hit something.