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Gives Isaac Loki's horns and grants a random chance for tears to fire in a cross (+) pattern. This chance is increased with Isaac's Tears stat. In Rebirth, the chance is increased with the player's luck. Although the pickup quote is "tears up," it does not actually increase the Tears stat.
- If the player shoots a charged Chocolate Milk shot, all of the cross pattern shots will be charged.
- Mom's Eye and The Inner Eye - The cross pattern shot is always fired.
- This does not work with Mutant Spider despite its similarities with The Inner Eye.
- Brimstone - When the cross pattern is shot instead of lasers firing in each direction it shoots the laser and shoots tears in the other directions that have the original damage of the tears before being altered by brimstone
- Mom's Knife - The player is surrounded by four knives. Can't fire the extra knives, but they all deal contact damage.
- In Rebirth, all four knives have a chance to be fired at once.
- Sometimes it may appear before being unlocked.