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| Collect 10 "tears up" items or pills in one runLachryphagy|
Lachryphagy is an unlockable passive item added in Booster Pack #4.
- Isaac's tears decelerate as they travel. Upon stopping or hitting an obstacle, they burst into 8 tears in all directions.
- Hitting an enemy will not cause them to burst.
- Tears can be fired into other tears to feed them, increasing their damage and the damage of the burst tears.
- If one tear is fed 5 other tears, it will immediately burst.
- The tears will have their damage added together, with the first consumed tear giving additional damage.
- Tears in the burst will deal half the damage the main tear would have.
- 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.: Lachryphagy does not affect regular Brimstone beams, but tears from other sources such as Isaac's TearsShoots 8 tears around Isaac, which retain the damage, shot speed, and special effects of his tears. Each tear shot by Isaac increases item charge by one. will burst into 8 Brimstone beams.
- Chocolate MilkGrants charged tears that deal greater damage when fully charged.: Rapidly firing small, uncharged tears can cause the fed tear to grow into a gigantic tear that will still deal fairly low damage, while feeding tears with charged tears will result in higher-damage tears.
- Dr. FetusTears are replaced by bombs that benefit from bomb-enhancing effects and slide a fixed range after being fired.: Overrides Lachryphagy.
- Epic FetusIsaac's tears are replaced with guided missiles, like those used by the Doctor's Remote.: Overrides Lachryphagy.
- Flat StoneTears bounce off the floor. Tears that hit an enemy after bouncing deal splash damage to all nearby enemies for 25% of Isaac's tear damage.: Overridden by Lachryphagy.
- IpecacReplaces tears with explosive and poisoning projectiles fired in an arc from the mouth.: Tears will burst into more explosive tears.
- 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.: Overrides Lachryphagy.
- Monstro's LungIncreases damage and grants a charged shot that fires multiple tears in the same fashion as Monstro.: The tears clump together soon after firing, causing potentially up to 20x base damage on a direct hit on an enemy.
- Pop!Replaces Isaac's tears with eyeballs that can bounce off of each other. The eyeballs are not limited by range, and will instead dissipate when they stop moving or when hitting an enemy or obstacle.: Tears behave erratically, with freshly fired tears usually behaving like Lachryphagy and burst tears like Pop!.
- ProptosisTears start out massive with high damage, and then shrink down and become weaker over a short range.: The tears most of the time fade out quicker than they can burst.
- Sinus InfectionAdds a chance to fire a booger which sticks to enemies and poisons them.: All tears have a chance to burst into boogers. Boogers will always burst into more boogers, though some of the boogers may incorrectly appear to be normal tears. When a booger sticks to a enemy, it will burst into 8 boogers which have a high chance of sticking again to the same enemy.
- 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 Lachryphagy.
- TechnologyReplaces tears with a piercing laser with unlimited range.: Overrides Lachryphagy.
- Tiny PlanetRange up and makes shot tears revolve around Isaac until they drop.: Both the Lachryphagy tears and their resulting burst tears follow the orbiting path of Tiny Planet.
- TrisagionTears are replaced with piercing white blasts of light.: Tears will split but cannot be grown by feeding tears.
- 20/20Grants double shot./ The Inner EyeGrants triple shot but decreases tears./ Mutant SpiderGrants quadruple shot but decreases tears.: Tears tend to clump together soon after firing for high damage shots. It may take more than 5 tears in total to cause a burst.
- Compound FractureIncreases range. Tears turn into bones, which shatter into 1-3 bone shards upon hitting an enemy or obstacle.: Bone tears split into 8 tears, each of which can shatter into bone shards.
- 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.: Fed tears split into 12 tears.
- Dead EyeIsaac's damage increases each time an enemy is hit. Damage is reset upon missing a shot.: The damage bonus from Dead Eye is very easy to keep as shots that would normally fly into a wall will usually float to a halt instead.
- Dead OnionGrants piercing and spectral tears. Increases tear size (without increasing damage) while greatly reducing range and shot speed.: Increased tear size from Dead Onion makes tears significantly larger and burst prematurely, with damage increased similar to max-sized Lachryphagy tears.
- EuthanasiaAdds a chance to fire needles. If a needle kills an enemy, it bursts into more needles.: Retains triple damage, ability to kill normally unkillable enemies, and tear burst. If the tears are fed, they burst into 8 like Lachryphagy; however, if they kill an enemy, they will burst into ten tears that can be fed, each of which will burst again into 8 tears.
- 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.: Tears look like Hameolacria. They can be fed and will burst into 8 tears that has Haemolacria's burst effect upon hitting obstacles or enemies.
- Kidney StoneRandomly while firing tears, Isaac will stop firing and turn red, where he will charge and release a lot of 'tears' in one go. In the burst of tears is a kidney stone which deals a lot of damage.: Fires a barrage of tears that tend to clump together into larger tears, along with a kidney stone which can also be fed and bursts.
- Jacob's LadderTears fire sparks of electricity in random directions upon hitting an obstacle or enemy.: Tears from Lachryphagy's burst create lasers when they hit an enemy or obstacle.
- A Lump of CoalThe more distance tears travel, the more damage they will do.: Tears continually grow in size without being fed other tears, but they will still only deal bonus damage based strictly on how far they travel. Burst tears will still grow in size and damage as they travel.
- Monstro's LungIncreases damage and grants a charged shot that fires multiple tears in the same fashion as Monstro. / Lead PencilAfter every 15 tears fired, Isaac will fire a high-damage cluster of tears.: Tears tend to clump together, becoming one giant tear which splits into 8 large tears.
- Rubber CementTears bounce off walls, enemies, and environmental objects.: Tears will damage and bounce off enemies normally and burst afterwards.
- Technology ZeroConnects Isaac's tears with electricity that can damage enemies.: Regular tears and split tears are all joined by lasers.
- Tractor BeamIsaac emits a beam from his face. Isaac's tears travel in the path of the beam.: All split tears will travel along the beam.
- Varicose VeinsTaking damage releases a ring of 10 high damage tears.: Upon taking damage, fires ten tears that can all burst.
- The name of this item is a reference to the behavior of insects, drinking tears of other creatures.
Lachryphagy tear growth, as they're being fed.