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There are various Items in the game that can affect Isaac's tears, giving them a special effect, such as the ability to petrify enemies, or slow them down.
Items and Their Effects on Tears
|Item Name||Item Appearance||Arrows||In-Game Tears||Tears Effect|
|Mutant Spider||Each shot fires four tears in a narrow spread.|
|Cupid's Arrow||Piercing tears that will travel through enemies.|
|Mom's Contacts||Tears have a chance to petrify enemies for a few seconds.|
|Mom's Eye||Each time a tear is fired, there is a chance for another tear to be fired from the back of Isaac's head.|
|The Parasite||Tears split into two upon contact with enemies or solid objects.|
|Chocolate Milk||Chargeable shots, that increase in size based on charge time.|
|The Common Cold||Tears have a chance to poison enemies.|
|The Inner Eye||Each shot fires three tears in a narrow spread.|
|My Reflection||Tears gain a "boomerang" effect and can reutrn to Isaac, at the cost of reduced range.|
|Ouija Board||Tears can pass through all environmental objects, but not enemies.|
|Polyphemus||Tears become larger and do increased damage, and can pass through enemies if they are killed in one hit.|
|Technology 2||A continous laser is fired, alongside tears with a lowered firing speed.|
|Tough Love||File:Tough Luck Shot.png||Tears have a chance to be replaced by teeth, which deal triple damage.|
|Number One||Range is greatly reduced, in exchange for high firing speeds.|
|Spoon Bender||Purple tears that can lightly home in on enemies.|
|The Mulligan||Tears have a chance to spawn Attack Flies.|
|Spider Bite||Tears have a chance to slow down enemies for 2.5 seconds.|
|Technology||Tears are replaced with a pulsing laser, which has infinite range and can pierce through enemies.|