Death's Touch is an unlockable passive item.
- +1.5 Damage
- -0.3 Tears
- Grants piercing tears.
- Increases tear size.
- Cosmetic effect: Tears are replaced by Death's scythes.
- While tear size is directly determined by damage, the scythes of Death's Touch are always bigger than their tear counterpart for any given damage value.
- BrimstoneTears are replaced by a laser beam that pierces through all enemies and obstacles in its path and deals high damage. Can only be fired after a short charge-up period.: Overrides Death's Touch, except for stat effects.
- Epic FetusIsaac's tears are replaced with guided missiles, like those used by the Doctor's Remote.: Overrides Death's Touch, except for stat effects.
- HaemolacriaTears are now fired in an arc. Upon hitting the floor, an obstacle, or an enemy, they burst into many smaller tears in all directions. Increases tear delay.: Stat effects apply. Fired tears will retain piercing effect; however, burst tears will not. All other effects do not apply.
- IpecacReplaces tears with explosive and poisoning projectiles fired in an arc from the mouth.: Fires explosive scythes. Piercing effect does not apply.
- Mom's KnifeIsaac'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.: Overrides Death's Touch, except for stat effects.
- Tech XTears 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.: Stat effects apply; however, tear size and cosmetic effect do not apply.
- TrisagionTears are replaced with piercing white blasts of light.: Stat effects and piercing effects apply; however, tear size and cosmetic effect do not apply.
- Compound FractureIncreases range. Tears turn into bones, which shatter into 1-3 bone shards upon hitting an enemy or obstacle./ Cricket's BodyGrants -1 Tear Delay and reduces Range. When tears hit an object or deplete their range, they spawn 4 smaller tears, whose Range and Damage scale with Isaac's./ The ParasiteIsaac's tears split in two when they hit something.: Scythes will split into scythe tears and retain all effects. The Parasite's split tears look like normal tears and not scythes.
- LachryphagyIsaac's tears decelerate as they travel. Upon stopping or hitting an obstacle, they burst into 8 tears in all directions. Tears can be fired into other tears to feed them, increasing their damage.: Scythe tears will retain all Lachryphagy effects.
- Monstro's LungIncreases damage and grants a charged shot that fires multiple tears in the same fashion as Monstro.: Significantly increased tear delay. Fires a barrage of very large scythes that retain piercing effect.
AQTN 1VQ8 (Treasure room adjacent to spawn)
H3YY 6MN9 (Treasure room adjacent to spawn in hard mode, first floor treasure room in normal mode)
Y678 Q9NC (First floor treasure room)
PS4 & PS Vita
BV4D V8WV (Treasure room adjacent to spawn)
83EW YKRR (First floor treasure room)
S11R GABM (First Floor Treasure Room ; North from Start)
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