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The Ludovico Technique
- Instead of firing tears, Isaac controls one floating tear that hovers over obstacles. This tear deals constant damage when held in place over an enemy.
- Ludovico tear movement speed is determined by the Shot Speed stat.
- Ludovico tear hits per second are determined by the Tears stat.
- When Death uses his The Hourglass attack, the tear is slow to respond but then moves so quickly that it is nearly impossible to use effectively.
- When there are no enemies in a room, the tear slowly floats towards the player.
- 20/20Grants double shot.: One smaller tear orbits the main tear.
- 8 Inch Nails+1.5 Damage Up. Replaces Isaac's tears with nails, which have increased knockback.: The tear becomes a nail, increases in size, damage, and provides minor knockback in the direction the tear moves.
- Apple!Increases tears. Adds a chance to fire a high-damage razor blade. / EuthanasiaAdds a chance to fire needles. If a needle kills an enemy, it bursts into more needles. / Tough LoveAdds a chance to shoot a tooth instead of a tear, which deals greater damage than regular tears.: The tear can gain the damage multiplier from each of the items, using the appropriate appearance when it happens. Euthanasia retains its instant kill ability against non-boss enemies.
- Blood ClotIncreases damage by 1 and range by 5 for tears fired from the left eye.: The tear steadily cycles between red and "normal," dealing more damage when red.
- 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.: Tear takes the shape of a very large laser ring. Shot speed is ignored. The Tears stat is ignored and damage is dealt very rapidly at a rate equivalent to 2 tear delay. This ring will always be present and doesn't need charging up like normal Brimstone would.
- Brimstone + A Lump of CoalThe more distance tears travel, the more damage they will do.: The ring increases in diameter, but not damage, the farther away it gets from Isaac.
- Brimstone + Spoon BenderGrants Isaac homing tears.: The ring reaches out to attack enemies near it, reforming into a ring when no enemies are present.
- Brimstone + TechnologyReplaces tears with a piercing laser with unlimited range.: The ring is visually identical to a normal Brimstone ring, but the 1.5x damage multiplier applies.
- Brimstone + Wiggle WormGives Isaac's shots a wave-like trajectory. +0.3 Tears up.: The ring takes the shape of a star.
- Azazel: Same effect as with Brimstone, but damage is halved.
- Azazel + 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.: Full damage of the laser ring is regained.
- Chemical PeelTears fired from left eye do increased damage.: Tear will alternate between "normal" and red, dealing more damage when red.
- Chocolate MilkGrants charged tears that deal greater damage when fully charged.: No damage increase, but results in -1 tear delay.
- The Common ColdAdds a chance to shoot poison tears, dealing damage over time when inflicted.: The tear pulses green, poisoning enemies.
- Compound FractureIncreases range. Tears turn into bones, which shatter into 1-3 bone shards upon hitting an enemy or obstacle.: Shoots out smaller tears when attacking an enemy. Scattered tears are spectral and piercing.
- Dead EyeIsaac's damage increases each time an enemy is hit. Damage is reset upon missing a shot.: Damage bonus increases until it hits the max of 2x. Since the controllable tear never hits the ground or wall, the bonus cannot be lost.
- Death's TouchIncreases Damage by 1.5, reduces Tears by 0.3 and increases tear size. Grants piercing tears. Tears are replaced by Death's scythes, which is a cosmetic effect only.: The tear becomes a scythe (vanity), but increases in size and damage
- Dr. FetusTears are replaced by bombs that benefit from bomb-enhancing effects and slide for a fixed time after being fired.: The bomb can be controlled until it explodes.
- Fate's RewardA blue head familiar that will follow Isaac and fire tears copying his tear effects and damage.: The familiar gains spectral and piercing tears, but otherwise fires normally.
- 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.: The tear starts bouncing at a rate somewhat below Isaac's fire rate, each bounce dealing splash damage.
- Flat Stone + IpecacReplaces tears with explosive and poisoning projectiles fired in an arc from the mouth.: Causes a poisonous explosion when it bounces instead of plain splash damage, as per normal Ipecac. The first bounce when entering a room does not explode, allowing moving the tear with less risk of self damage.
- The Forgotten: The tear follows the Forgotten when in its skeleton form. It can be hit with its melee attack to propel it, making it do more damage. When switching to the Soul, the tear spawns on top of the player.
- GodheadIncreases damage and range while reducing tears and shot speed. Grants homing tears and tears gain a damaging halo.: The tear homes towards nearby enemies and gains a large damaging aura.
- Guppy transformation: A large number of flies is rapidly deployed whilst controlling the Ludovico tear.
- IncubusA demonic familiar that follows Isaac and shoots tears identical to Isaac's in terms of damage, range, fire rate, and effects.: Isaac gains a controlled tear while also being able to shoot normally with Incubus. Incubus's tears gain piercing and spectral properties.
- The Inner EyeGrants triple shot but decreases tears.: Two smaller tears orbit the main tear.
- Lost ContactEvery tear has a small shield which will allow it to block one enemy projectile.: Tear will block enemy tears without disappearing.
- A Lump of CoalThe more distance tears travel, the more damage they will do.: The tear becomes larger the further away it is from Isaac, increasing in damage.
- Mom's ContactsAdds a chance to shoot petrifying tears, which stop enemies in place and prevent them from moving or attacking. Range up.: Tear randomly alternates colors, which randomly petrifies enemies.
- Mom's PerfumeAdds a chance to shoot fear tears and decreases tear delay by 1.: Tear gains a chance to give the fear effect.
- Mom's WigAdds a chance to spawn blue spiders when firing tears. Restores 1 red heart.: The item causes spiders to spawn rapidly when moving the tear.
- Monstro's LungIncreases damage and grants a charged shot that fires multiple tears in the same fashion as Monstro.: Tear turns red and does more damage.
- Tear becomes a cluster of variously sized tears spread over a small area. The tears move at the same speed when controlled but constantly move around each other.
- Mutant SpiderGrants quadruple shot but decreases tears.: Three smaller tears orbit the main tear.
- My ReflectionGives Isaac's tears a boomerang effect, and increases range and shot speed.: The tear moves much faster.
- Number One+1.5 tears, -17.62 range: The tear deals damage to enemies much faster, with the range penalty having no effect.
- The ParasiteIsaac's tears split in two when they hit something.: Shoots out smaller tears when attacking an enemy. Scattered tears are spectral and piercing.
- PauseFreezes all enemies until a fire button is pressed.: The tear deals damage, even if the enemies are stopped. Moving the tear unpauses the enemies.
- Pulse WormShots pulse in size.: The tear pulsates in midair, expanding and contracting. This works with normal tears as well as 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..
- Spoon BenderGrants Isaac homing tears.: Tear will slightly gravitate towards enemies near it
- Strange AttractorPickups, trinkets, and monsters are magnetically attracted to Isaac's tears.: Enemies, items and even most bosses will be sucked to the single floating tear, dealing constant damage while keeping Isaac well away from harm, making this combination extremely effective in almost all scenarios.
- TechnologyReplaces tears with a piercing laser with unlimited range.: The tear becomes a large laser ring, which visually looks like a shot fired by 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.. Shot speed is ignored. The Tears stat is ignored and damage is dealt very rapidly at a rate equivalent to 2 tear delay.
- Tear DetonatorWhen used, will detonate any tears currently on the screen and cause each one to split into 6 more tears which will fire in a circle, similar to Tammy's Head.: The tear explodes into six smaller tears, then reappears next to the player.
- ???'s Only FriendSummons a big attack fly that can be controlled with the shooting direction-keys. / Robo-Baby 2.0Fires lasers at any enemy in its line of sight and moves based on the direction Isaac is firing tears.: The tear and familiar(s) travel together, as they are controlled in the same way. Because the familiars' travel speeds are not affected by Isaac's shot speed, they only travel in the same spot when Isaac has exactly the amount of shot speed to sync them up.
- Anti-Gravity-2 Tear Delay. Tears float in position until firing ceases, after which they will fly off in the direction they were shot in.: Overridden by The Ludovico Technique.
- 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.: Overridden by The Ludovico Technique.
- Cursed EyeGrants charged tears that can be fired in a tight burst of four. Getting hit while charging will teleport Isaac into another room.: No effect.
- Epic FetusIsaac's tears are replaced with guided missiles, like those used by the Doctor's Remote.: Overrides The Ludovico Technique.
- ExplosivoIsaac's tears have a chance to stick to enemies and explode.: Tear will alternate between "normal" and black. If it touches an enemy, it will stick to it, grow in size, then explode. The tear can not damage anything or be controlled when stuck to an enemy.
- The tear will grow very quickly when stuck to an enemy and pop without dealing damage, instead of the normal Explosivo delay and explosion.
- Fire MindGrants flaming tears that deal burning damage over time. Tears have a chance to explode on impact with an enemy, which creates a fire at the location of the explosion.: Tears retain the ability to ignite enemies and explode. Tears respawn at Isaac's location after exploding.
- Overridden completely by The Ludovico Technique, other than tear appearance.
- Ghost PepperAdds a chance to shoot a fire that damages enemies and remains in place until it deals enough damage or the room is left.: Fires created from Ghost Pepper will destroy the tear and cause it to respawn on Isaac.
- Homing Tears: The tear slowly homes toward the nearest enemy. Once locked in an enemy moving the tear somewhere else becomes harder.
- Hook WormTears move shifting left to right forming a path of right angles. +10 to Range (effective range remains about the same).: Tear moves in a zig-zag pattern while controlled.
- Invulnerability: Tear cannot be moved while in effect, but will still do damage.
- IpecacReplaces tears with explosive and poisoning projectiles fired in an arc from the mouth.: Overridden by The Ludovico Technique. (No damage increase or explosion.)
- +4 damage bonus, no explosion.
- Loki's HornsGives a random chance for projectiles to fire in all 4 cardinal directions.: The Ludovico tear will sometimes shoot 4 smaller tears in each direction, depending on luck and tear rate.
- Mom's EyeAllows Isaac to fire tears from the back of his head.: The Ludovico tear will sometimes shoot a smaller tear in a random direction, depending on luck and tear rate.
- 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.: The tear becomes a controllable knife that deals double Isaac's damage. Effective shot speed is lowered. Tears stat is ignored and damage is dealt at a rate equivalent to 5 tear delay.
- Mom's Knife + 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.: Flat Stone is overridden completely.
- Mom's Knife + GodheadIncreases damage and range while reducing tears and shot speed. Grants homing tears and tears gain a damaging halo.: Replaces the Ludovico tear with Mom's Knife but removes the Godhead aura.
- Mom's Knife + TechnologyReplaces tears with a piercing laser with unlimited range.: Creates an uncontrollable laser ring centered on Isaac. The knife becomes stuck under Isaac and cannot be fired.
- Mom's Knife + Monstro's LungIncreases damage and grants a charged shot that fires multiple tears in the same fashion as Monstro.: Monstro's Lung is overridden completely.
- Multidimensional BabySpawns a familiar that will follow Isaac's movements on a 2.5 second delay. Tears that pass through the baby will be doubled and increase in speed.: No effect.
- An additional Ludovico tear is spawned when it passes through Multidimensional Baby, at the start of every room, and persists like the Ludovico tear itself. However, it cannot be controlled; it instead slowly follows Isaac.
- Notched AxeIsaac holds the axe above his head for as long as the spacebar button is held (or until he leaves the room). While holding the axe, Isaac can break any rock he touches, but cannot attack or pick up other items.: The Ludovico tear cannot be moved while Notched Axe is held up.
- ProptosisTears start out massive with high damage, and then shrink down and become weaker over a short range.: The closer the tear floats to Isaac, the larger it is. The farther away, the smaller.
- Pupula DuplexTransforms Isaac's tears into a wide arc shape which gives them a much larger hitbox. Gives Isaac spectral tears which allows them to travel through objects in the environment (i.e. rocks).: Decreases the tear size by taking the form of a Pupula Duplex tear; however, it travels faster.
- Red CandleThrows a persistent flame that deals high damage and diminishes as it damages enemies or blocks shots.: The tear disappears upon contact with a flame created by the candle and reappears near Isaac, slightly shrinking the flame.
- Ring WormGives Isaac spinning shots.: The tear spins rapidly in small circles.
- Sinus InfectionAdds a chance to fire a booger which sticks to enemies and poisons them.: The tear can occasionally stick to an enemy. If the enemy does not die quickly, the tear pops and a new one spawns.
- Tech.5Grants a unlimited range piercing laser with random rate of fire that does not replace tears. The laser might occasionally fire with the effect of a random item or trinket, such as Hook Worm, Spoon Bender or Tiny Planet.: The tear controls as usual, and Isaac fires the laser towards the tear relative to his position, rather than in the direction the player is moving the tear.
- Tech.5 + Analog Stick+0.3 tears up. Allows Isaac to fire tears diagonally.: Laser is fired directly at the tear while it is being moved, instead of being limited to cardinal directions.
- 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 The Ludovico Technique.
- Technology 2Decreases damage and replaces right eye tears with a unlimited range, piercing laser which fires continuously.: The tear controls as usual, and Isaac fires the laser towards the tear relative to his position, rather than in the direction the player is moving the tear. Technology 2's damage penalty still applies. Laser becomes spectral.
- Technology 2 + Analog Stick+0.3 tears up. Allows Isaac to fire tears diagonally.: Laser is fired directly at the tear while it is being moved, instead of being limited to cardinal directions.
- Technology ZeroConnects Isaac's tears with electricity that can damage enemies.: No effect without additional items. Extra tears orbiting the main one or familiar tears will generate arcs to the controlled tear.
- Tiny PlanetRange up and makes shot tears revolve around Isaac until they drop.: The tear controls strangely. It orbits Isaac slowly when not controlled, and when controlled, the tear's movement is distorted. Additionally, the tear's range becomes limited to Tiny Planet's orbit distance.
- Tractor BeamIsaac emits a beam from his face. Isaac's tears travel in the path of the beam.: The Ludovico Technique overrides the beam's effect.
- Trinity ShieldIsaac gains a shield that protects him from enemy shots.: The controls of the tear and the shield overlap, making it impossible to consistently control both.
- The WizTears simultaneously fire out of both eyes diagonally, similar to the effect of the R U A Wizard? pill. Isaac's tears also travel above all obstacles.: A smaller Ludovico tear will spawned and revolves round the main one. Also, the Ludovico tear now moves in a very unusual way, up is up-right, down is down-left, left is left-up, right is right-down. This can be counteracted by holding the keys or d-pad in its associated path (up-right to make it go up and so forth with the other keys).
- The Ludovico Technique is a reference to Anthony Burgess' novel A Clockwork Orange and Stanley Kubrick's film adaptation, where it was referred to as "Ludovico's Technique." The technique involved headgear which forced the patient's eyelids open (hence "Controlled Tears") while watching violent films under nausea-inducing drugs, conditioning them against violence.
KPRZ M83V (First floor treasure room)
ZYS1 ONMS (Treasure room adjacent to spawn)
VLZW 7CJ8 (Treasure room adjacent to spawn)
MX26 V47J (treasure room adjacent to spawn) (both modes)
KYSL MRKZ (treasure room adjacent to spawn)
S11S E632 (First floor treasure room)
0H0T MKNS (First floor treasure room)
DQBE T9RH (First floor treasure room)
GEYN TXS7 (First floor treasure room)
KK92 7DTD (First floor treasure room)
191Z NVJA (Treasure room adjacent to spawn)
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