Tears

The Tears attribute determines the rate of fire of the character and is represented by 3 arrows. This attribute is also known as the tear delay (the delay between successive shots, as opposed to the inverse 'tears per second'); a higher tears stat means a shorter delay. The tear stat is a measurement of tear frequency, as opposed to Shot Speed, which measures how fast those shots move.

Tear Delay Calculation
The formula for tear delay is:

$$ \text{Tear Delay} = \begin{cases} 16 - 6 \times \sqrt{T \times 1.3 {+} 1}             & \text{if } T \geq 0\\ 16 - 6 \times \sqrt{T \times 1.3 {+} 1} - 6 \times T & \text{if } T < 0 \text{ and } T > -0.77\\ 16 - 6 \times T                                   & \text{if } T \leq -0.77 \end{cases} $$

"T" in the above formula is equal to the normal tears stat, with all adjustments added together. For example, picking up would grant 0.7 tears, making Isaac's tear delay 7.7, which is rounded down to 7.

The minimum tear delay that can be reached with regular tears up items is 5, giving Isaac a soft cap of 5 tears fired per second. With items that directly reduce tear delay, tear delay can be reduced further, down to a hard minimum of 1 tear delay (15 tears fired per second).

The number of tears per second that Isaac fires is found by the formula: $$\frac{30}{\text{Tear Delay} + 1}$$.

Conversely, Tear Delay can be calculated from the fire rate given ingame with the formula $$\frac{30}{\text{Fire Rate}}-1$$. Note that the fire rate given by the ingame HUD is rounded.

The tear delay hard cap of 1 is removed, allowing Isaac to shoot much faster than before with the right combination of items. Additionally, many items have had their effects changed to change Isaac's tears fired per second rather than his tear delay.
 * The absolute maximum fire rate achievable is 120.

Characters
Different characters start with different initial tears:
 * -0.05
 * : -0.1
 * +0.5, x1/3
 * /: ±0.75
 * Tainted Eden's base tears rerolls every time they take damage unless they have.
 * : -2
 * : -1.9
 * / : x0.5
 * : +0.277 for Jacob, -0.1 for Esau
 * : -0.4
 * : -0.5, then x0.66
 * : -0.1
 * Tears fired per second is halved and then increased by 2 while berserking.
 * : x0.33
 * : -0.1
 * : -2.2
 * : -0.5
 * : +0.277
 * All other characters (,, , , , , , , , , , , , , , , , , , , and ) have the base +0 tears.

Direct modifiers to Tear Delay/Tears Fired per Second
Several items directly modify tear delay after the main calculation:
 * Many items that used to modify tear delay now modify tears fired per second instead. They still allow the soft cap of 5 tears per second to be broken, but now have a greater impact on runs that have a lower fire rate compared to those with a higher one; this is in contrast to Afterbirth+, where the opposite was true.
 * : -2 tear delay
 * +1 tears fired per second
 * : tear delay * 3
 * Cancer: -2 tear delay
 * +1 tears fired per second
 * : -1 tear delay
 * +0.5 tears fired per second
 * : tear delay * 2.5
 * This fire rate modifier does not affect Isaac's actual tears stat; it's only the rate at which fully charged shots can be fired.
 * Cracked Crown: -20% tear delay
 * : Boosts the tears fired per second given by normal tears upgrades by 20%
 * : -1 tear delay
 * +0.5 tears fired per second
 * : tear delay * 2.5
 * : tear delay / 2 (while at max "charge")
 * : tear delay * 2
 * : tear delay * 1.5
 * : -1 tear delay
 * +0.5 tears fired per second
 * : (tear delay * 2) + 10
 * : tear delay / 2
 * : Tears fired per second * 2.5
 * : (tear delay * 2) + 10
 * Tears fired per second / 3
 * : -2 tear delay (after taking damage for the current room)
 * +1 tears fired per second
 * : -1 tear delay
 * +0.5 tears fired per second
 * : tear delay * 4.3
 * : (tear delay * 2.1) + 3
 * : -1 tear delay
 * +0.5 tears fired per second
 * : (tear delay * 2.1) + 3
 * : -4 tear delay while blue aura is active
 * : +2 tears fired per second
 * : (tear delay / 4) - 2
 * Tears fired per second * 5.5
 * : tear delay * 1.5
 * : (tear delay * 2.1) + 3
 * (tear delay * 2)
 * : +0.4 tears fired per second per bone heart lost
 * : +2 tears fired per second
 * //: +0.5 tears fired per second
 * : Tears fired per second * 4
 * : (Tears fired per second / 2) + 2
 * : +0.5 tears fired per second
 * //: +1.5 tears fired per second while standing on unique creep
 * This also triples fire rate if the creep is in contact with white poop
 * : +1.2 tears fired per second on the first hit, then +0.4 tears fired per second on subsequent hits
 * : +1 tears fired per second on touching the first beam of light, then +0.5 tears fired per second on subsequent beams touched
 * : +0.4 tears fired per second for every room cleared without taking non-self damage, up to a max of +2 tears fired per second
 * : +0.75 tears fired per second (halves if Isaac leaves the room he used it in, and wears off at the rate of one room clear per use)

Other

 * Tears up pills increase tears by 0.35 and tears down pills decrease tears by 0.28.
 * In co-op, Cry Baby will occasionally briefly increase tears. Dark Baby will occasionally briefly increase all stats, including tears. Buddy Baby will occasionally briefly grant the effect, which increases tears.