Upon entering a room, poisons all enemies, dealing double Isaac's tear damage. Killing enemies leaves a small, short lasting pool of green creep on the ground.
When Isaac is hit, 1 point of an item's charge is filled.
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.
Ball of Tar
Adds a chance to shoot slowing tears and the character leaves a trail of slowing creep behind as he moves, impeding enemies' speed.
A glass of milk follows Isaac and spills on the floor upon taking damage. After the milk spills, Isaac's tear delay is decreased by 2 for the rest of the room.
Head of the Keeper
Isaac's tears become coins and now have a chance to drop pennies on the floor upon successfully hitting an enemy.
Spawns a large orbital familiar that blocks enemy projectiles and deals slight contact damage to enemies.
Adds a chance to shoot petrifying tears, which stop enemies in place and prevent them from moving or attacking. Range up.
Isaac leaves a trail of black powder on the floor. Walking in a circle will spawn a pentagram symbol on the floor, which deals 10 damage per tick to any enemies inside it.
Adds a chance to shoot concussive tears, causing enemies to walk around randomly.
Continuously firing tears for several seconds causes Isaac to drop a Butt Bomb. Butt Bombs explode for 50 damage like normal bombs, but also deal 10 damage to all enemies in the room and daze them for a short period of time.
Spawns a familiar that fires clusters of tears. Must be charged before shooting.
The Inner Eye
Grants triple shot but decreases tears.
Allows Isaac to hold 1 additional trinket.
Charm of the Vampire
Heals the character for half of a red heart for every 13 monsters killed.
Grants two soul hearts. Isaac now repels enemy projectiles.
+1 luck. Spawns a fairy familiar that points out secret room entrances and tinted rocks.