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Epiphora is a passive item added in Afterbirth.
- Tear delay gradually decreases as the player shoots in one direction. Accuracy also decreases as the fire rate increases.
- At max "charge", it will reduce tear delay by half, rounding down.
- Rate of fire returns to its original value if Isaac stops firing, changes firing directions, uses an active item, or is hit.
- Being hit, changing rooms, and using items no longer reset the Epiphora bonus.
- During the delay when transitioning between rooms, picking up an item, or using an active item, it's possible to change firing direction without resetting the bonus.
- Epiphora technically works with items that require a charge (such as Monstro's LungIncreases damage and grants a charged shot that fires multiple tears in the same fashion as Monstro.) but requires releasing the key or button, causing players to lose the effect.
- 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 Epiphora.
- Chocolate MilkGrants charged tears that deal greater damage when fully charged.: Overrides Epiphora.
- Epic FetusIsaac's tears are replaced with guided missiles, like those used by the Doctor's Remote.: Overrides Epiphora.
- Lilith: Lilith and her IncubusA demonic familiar that follows Isaac and shoots tears identical to Isaac's in terms of damage, range, fire rate, and effects. cannot gain extra fire rate from Epiphora.
- 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 Epiphora.
- Monstro's LungIncreases damage and grants a charged shot that fires multiple tears in the same fashion as Monstro.: Overrides Epiphora.
- 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.: Overrides Epiphora.
- Continuum+2.25 Range Up. +1.5 Tear Height. Isaac's tears travel through walls and appear out of the opposite wall. Isaac's tears also travel over rocks and objects.: Reduces the need to change firing direction allowing Isaac to maintain the increased rate of fire.
- Dr. FetusTears are replaced by bombs that benefit from bomb-enhancing effects and slide a fixed range after being fired.: Firing bombs continually will decrease tear delay.
- The Forgotten: When tapping the attack button in a single direction repeatedly, the Ephiphora effect will cause the bone swings to speed up.
- 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.: Continually firing tears will decrease tear delay.
- How to JumpGives Isaac the ability to jump (over gaps, spikes, etc.).: Changing firing direction while jumping does not reset the bonus, similar to when changing rooms.
- IncubusA demonic familiar that follows Isaac and shoots tears identical to Isaac's in terms of damage, range, fire rate, and effects.: Incubus's fire rate will match Isaac's.
- The Inner EyeGrants triple shot but decreases tears./ Mutant SpiderGrants quadruple shot but decreases tears.: Increases firerate as tears are continually fired.
- IpecacReplaces tears with explosive and poisoning projectiles fired in an arc from the mouth.: Continually firing explosive shots will increase firerate.
- The Ludovico TechniqueInstead of firing tears, Isaac controls one floating tear that hover over obstacles. This tear deals constant damage when held in place over an enemy.: Fire rate increases while moving the tear in one direction; has a negligible effect during normal gameplay.
- MarkedIsaac will now fire tears automatically directed at a red target on the ground which is controlled by the player. This allows for a full 360 degree tear firing radius. Can be overridden by other tear modifiers such as Mom's Knife or Brimstone.: Rate of fire only increases so long as mark is continuously moved in one direction.
- Rubber CementTears bounce off walls, enemies, and environmental objects.: Reduces the need to change firing direction allowing Isaac to maintain the increased rate of fire.
- TechnologyReplaces tears with a piercing laser with unlimited range.: Continually firing lasers will increase firerate.
- Tractor BeamIsaac emits a beam from his face. Isaac's tears travel in the path of the beam.: Fire rate still increases when shooting in one direction, but will stay on the line (i.e. no loss in accuracy).
- Loki's HornsGives a random chance for projectiles to fire in all 4 cardinal directions.: Allows for firing in multiple directions at once, decreasing need to change firing direction.
- Mom's EyeAllows Isaac to fire tears from the back of his head.: Allows for firing forward and behind, decreasing need to change firing direction.
- Epiphora is an overflow of tears onto the face.
PC 0RK6 FCRZ (Treasure room adjacent to spawn) (Both modes)