Reveals and opens all Secret Room and Super Secret Room entrances.
Grants a chance to trigger the Book of Shadows effect upon taking damage, creating a shield that nullifies all types of damage for 10 seconds. Also converts "bad pills" into "good pills".
Adds a chance to shoot a tooth instead of a tear, which deals greater damage than regular tears.
Destroys rocks upon contact with Isaac. Adds one heart container and lowers Speed.
There will be 2 items available to choose from after defeating a boss. Choosing 1 item causes the other to disappear.
All sources of damage that would cause more than one half heart of damage are reduced to one half heart instead.
Inflicts poison to enemies who make contact with Isaac. Speed down.
Grants two soul hearts. Isaac now repels enemy projectiles.
The Small Rock
Increases damage by 1, increases tears by 0.2, and decreases speed by 0.1.
Isaac is followed by a small blue cross that will drop a Soul Heart every 4 rooms.
If the character has half a red heart or no red hearts after taking damage, it triggers the Book Of Shadows effect, creating a shield that nullifies all types of damage for 5 seconds. Also allows entrance into The Chest.
Spawns a familiar that floats slowly around the room on a zig-zag pattern similar to Boom Fliesdamaging enemies it passes through.
Isaac's tears split in two when they hit something.
Increases damage by 0.5, tears by 0.7 and grants two soul hearts upon pickup.
If the character has half a red heart or no red hearts after taking damage, it triggers The Necronomicon effect, damaging all enemies in the room. Also allows entrance into the Dark Room.
Tears have a 1/6 chance of spawning allied blue flies when they hit an enemy.
Grants the combined effects of the Blue Map, Treasure Map, and The Compass, revealing the floor layout and all special rooms, including Secret Rooms and Super Secret Rooms.
Increases Damage and Speed, plus adds one Soul Heart.
The Ludovico Technique
Instead of firing tears, Isaac controls one floating tear that hover over obstacles. This tear deals constant damage when held in place over an enemy.
Allows Isaac to walk across gaps one square across by automatically placing a ladder between the two walkable sections.
The Inner Eye
Grants triple shot but decreases tears.
Grants one Heart Container, +0.3 Damage, +0.2 Tears, +0.25 Range, +0.3 Speed, and +0.5 Tear Height.
Reveals all special rooms (except secret rooms of any kind).
The Common Cold
Adds a chance to shoot poison tears, dealing damage over time when inflicted.
Pickups, trinkets, and monsters are magnetically attracted to Isaac's tears.
Increases damage, and adds 1 heart container.
Adds one filled heart container and increases Shot Speed.
Reduces all Shop prices by 50%, rounded down to 7 coins for an item, rounded up to 2-3 coins for a pickup.
Isaac can hold 2 cards at once and all pills are replaced by cards.
Increases tears by 0.4, and spawns 2 Soul Hearts pickups.
Spirit of the Night
Grants spectral tears and flight.
Adds a chance to shoot slowing tears, reducing speed of enemy movement and any projectile fired by them.
When hit, spawns up to 2 blue spiders.
Reveals type of adjacent rooms, including location for secret rooms and super secret rooms.
Increases speed by 0.3 and shot speed by 20%.
Tears shrink and do much less damage, but fire in very rapid succession.
After Isaac takes damage, this fly will deal continuous touch damage to whatever enemy caused the damage until it is dead. The fly will then systematically attack 1 enemy at a time until the room is cleared.
Sets your key count to the maximum of 99.
All types of fly except Boom Fly and Red Boom Fly become passive and slowly move towards Isaac. Does not prevent contact damage.
A familiar that follows Isaac around shooting blood tears.
Wanders about the room, occasionally spawning blue spiders.
Using an activated item while it's not charged will charge it and Sharp Plug does 2 full heart damage to Isaac.
Tears bounce off walls, enemies, and environmental objects.