20/20 is a passive item.
- Isaac fires two tears at once, one from each eye.
- 0.75x damage multiplier.
- Blood Clot / Chemical Peel: Every second row of tears has increased damage.
- Brimstone: Two Brimstone shots are fired, without an increase in charge time.
- Diplopia: Every additional 20/20 adds 2 more tears in a tight pattern.
- Doctor's Remote / Epic Fetus: Replaces the single missile strike with a barrage of two consecutive missiles.
- The Inner Eye / Mutant Spider: Adds two/three tears to each shot, with no extra fire rate decrease.
- Keeper: Fires 5 tears with no fire rate decrease.
- The Ludovico Technique: The Ludovico tear gains one smaller tear orbiting the main one, each dealing the same amount of damage.
- Monstro's Lung: Adds two tears to the tear barrage, for a total of 16.
- Sprinkler: Fires two tears at once that almost completely overlap each other.
- Technology: Fires two technology shots simultaneously.
- Tractor Beam: Both tears are fired along the beam. Only one tear can be seen, as they overlap each other.
- The Wiz: Two tears are fired in each direction.
- Brimstone: Overrides 20/20.
- The Inner Eye: Overrides 20/20.
- Kidney Stone: Increase number of tears in tear barrage; however, only fires one stone.
- Loki's Horns: Only occasionally fires one tear in the other three directions.
- Mom's Eye: Only occasionally fires one tear out of the back of Isaac's head.
- Mom's Knife: Overrides 20/20.
- Monstro's Lung: Overrides 20/20.
- Mutant Spider: Overrides 20/20.
- Sad Bombs: Does not affect the number of tears when bombs explode.
- Technology: Overrides 20/20.
- Varicose Veins: No effect on number of tears when taking damage.
- 20/20 is an idiom that refers to someone with near-perfect vision.
- Despite only having one eye, Cain shoots two tears at once with this item.
- This item is used in Seeing Double (challenge #40).
PC STDX QSC8 (Treasure Room adjacent to spawn)
PC NYJK 3QDN (Treasure Room adjacent to spawn)
PC AFJE 9RXX (Treasure Room adjacent to spawn)
PC Y6FY DZH6 (Treasure Room next to spawn)
PS4 GD7V 66ZX (Treasure Room adjacent to spawn)
Vita 92SM AXWG (Treasure Room next to spawn)
3DS H3Y3 X22S (First floor Treasure Room)
XboxOne 228H QN22 (First floor Treasure Room above spawn)
Switch GBDPZXGJ (Eden starts with it)
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