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Trisagion is an unlockable passive item added in Booster Pack #4.
- Tears are replaced with piercing white blasts of light.
- Blasts deal 33% of regular tear damage, but can hit the same enemy multiple times.
- Blasts do not knock back enemies.
- Since the blasts can strike one enemy multiple times, low shot speed can be very beneficial whereas high shot speed may lower effective damage.
- Walking backwards while firing can allow tears to move slower, making it useful for increasing damage output.
- Azazel: Azazel's short range Brimstone overrides Trisagion.
- 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 Trisagion.
- 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./ Compound FractureIncreases range. Tears turn into bones, which shatter into 1-3 bone shards upon hitting an enemy or obstacle./ The ParasiteIsaac's tears split in two when they hit something.: Split blasts are not generated on hitting enemies, only on obstacles and walls, as well as floors for Cricket's Body.
- Dead EyeIsaac's damage increases each time an enemy is hit. Damage is reset upon missing a shot.: Overridden by Trisagion.
- Dr. FetusTears are replaced by bombs that benefit from bomb-enhancing effects and slide a fixed range after being fired.: Overrides Trisagion.
- Epic FetusIsaac's tears are replaced with guided missiles, like those used by the Doctor's Remote.: Overrides Trisagion.
- EuthanasiaAdds a chance to fire needles. If a needle kills an enemy, it bursts into more needles.: Beams will occasionally do triple damage, but will not instantly kill enemies or burst.
- Eye of BelialGrants piercing tears. After piercing one enemy, tears start homing and deal double damage.: Overridden by Trisagion.
- 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.: Beams continually grow and shrink. Shrunken beams do roughly 75% damage of normal beams.
- 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.: Functions otherwise as normal, but all blasts deal the same reduced damage.
- Jacob's LadderTears fire sparks of electricity in random directions upon hitting an obstacle or enemy.: Electric arcs are not generated on hitting enemies, only on obstacles and walls.
- 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.: The blasts will slow down and float like Lachryphagy tears and eventually burst, but can not consume each other.
- A Lump of CoalThe more distance tears travel, the more damage they will do.: No effect, the blasts' damage is unchanged.
- 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 Trisagion.
- 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.: The baby cannot duplicate Trisagion blasts.
- 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.: The blasts will slow down and float like Pop! tears, but will not bounce off each other.
- Sinus InfectionAdds a chance to fire a booger which sticks to enemies and poisons them.: Overridden by Trisagion.
- 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 Trisagion.
- TechnologyReplaces tears with a piercing laser with unlimited range.: Overrides Trisagion.
- Technology ZeroConnects Isaac's tears with electricity that can damage enemies.: Overridden by Trisagion.
- ParasitoidAdds a chance to fire an egg sack which spawns slowing creep and spawns a blue fly or spider upon hitting an enemy.: Overridden by Trisagion.
- Chocolate MilkGrants charged tears that deal greater damage when fully charged.: Fully charged Trisiagon blasts deal 3 times more damage, reaching Isaac's base damage.
- GodheadIncreases damage and range while reducing tears and shot speed. Grants homing tears and tears gain a damaging halo.: Although the damaging aura isn't visible, it still exists and is not affected by Trisagion's damage reduction.
- Guppy (Transformation): As it hits multiple times, it spawns multiple flies per tear making it very strong.
- Homing tears: The blasts can deal extra damage as they remain in contact with enemies longer.
- IpecacReplaces tears with explosive and poisoning projectiles fired in an arc from the mouth.: Ipecac's damage boost applies; the light beam causes explosions dealing full damage when it impacts something or runs out of range. Use with caution. Having PyromaniacIsaac heals 1 heart instead of taking damage from an explosive source. Adds 5 bombs. or Host HatA host familiar that sits on Isaac's head and has a random chance to block enemy shots and retaliate with 3 tears. Grants immunity to explosions. is recommended.
- 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.: Behaves exactly as expected except everything looks like beams.
- Lead PencilAfter every 15 tears fired, Isaac will fire a high-damage cluster of tears.: Fires barrage of beams occasionally.
- 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.: The beam becomes controllable, still dealing reduced damage but at very high rate.
- 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.: Beams will now fire towards crosshair.
- Monstro's LungIncreases damage and grants a charged shot that fires multiple tears in the same fashion as Monstro.: Fires barrage of beams.
- My ReflectionGives Isaac's tears a boomerang effect, and increases range and shot speed.: In addition to the usual effect, lengthens the Trisagion blasts for a much larger damage-dealing area.
- Mysterious LiquidTears leave a small, short lasting pool of creep on impact or when their range is depleted.: Causes a large trail of creep. The effect stacks, which causes heavy damage (even to Hush).
- Pisces-1 Tear Delay, adds knock-back shots and increases tear size.: Blasts can knock back enemies.
- ProptosisTears start out massive with high damage, and then shrink down and become weaker over a short range.: Base damage is doubled and beam damage is boosted to about 65%. Blasts lose very little power as they travel further.
- Rubber CementTears bounce off walls, enemies, and environmental objects.: The blasts still pierce enemies, but bounce off obstacles and walls.
- Varicose VeinsTaking damage releases a ring of 10 high damage tears.: When hurt, 10 beams are fired in all directions.
- Trisagion is based on this Steam Workshop item by x Wyvern x.
- Trisagion's tears are similar in appearance to Brimstone beams with the shortest range possible.
- The name is a reference to one of the oldest christian hymns.