Binding of Isaac: Rebirth Wiki
Binding of Isaac: Rebirth Wiki

Added in Afterbirth †

Haemolacria is an unlockable passive item added in The Binding of Isaac: Afterbirth †.


  • Tears are fired in an arc. Upon hitting the floor, an obstacle, or an enemy they burst into many smaller tears in all directions.
  • Tears down - (Delay * 2) + 10
  • Increases damage by about 31%.``
    • The scattered tears deal random damage that is around 50-80% of the main tear.
    • Added in Repentance +1 damage up and 1.5x damage multiplier.


  • Higher shot speed lowers the arc of the main shot, whereas lower speed heightens it, resulting in a very minor change in effective range.
    • The split tears are affected normally by shot speed.
  • The tear height stat is entirely ignored for both the main shot and the split tears.
  • The main tear has a roughly 1.71x size multiplier.
  • Added in Repentance Getting this item can make the battle with The Beast difficult, as tears will be shot at an 80° angle and leave from the top of the screen, making it extremely hard to aim.


  • Brimstone Brimstone: Significantly increased tear delay. Isaac fires a large arcing tear that fires several Brimstone beams in random directions upon bursting.
    • This does not apply to Azazel Azazel/Tainted Azazel Tainted Azazel's default brimstone beam.
    • Chocolate Milk + Brimstone: Chocolate Milk allows for rapid firing of Haemolacria tears, giving Isaac the ability to flood the room with Brimstone lasers, allowing for instant-kill potential
  • Chocolate Milk Chocolate Milk: Increased tear delay. Completely charged shots and their burst tears are larger and deal higher damage than normal. Chocolate Milk also allows low-damage Haemolacria shots to be fired rapidly.
  • Compound Fracture Compound Fracture/The Parasite The Parasite: Similar to Cricket's Body, tears will split, scattering massive amounts of smaller tears across the room. Hits on walls or the floor absorb most of the extra tears.
  • Cricket's Body Cricket's Body: A single tear can scatter massive amounts of smaller tears in a wide area regardless of what it hits.
  • Dead Eye Dead Eye: Both the main tear and the burst tears can increase the damage bonus, but missing the burst tears won't reset it.
  • Dr. Fetus Dr. Fetus: Significantly increased tear delay. Isaac fires a large arcing tear reminiscent of a bomb that scatters into 3-5 bombs that explode simultaneously.
  • The Forgotten The Forgotten: Several blood tears are scattered upon the bone club hitting an enemy. It also increases the size of the club, similar to Polyphemus Polyphemus. The throw is unaffected and does not scatter blood tears.
  • Added in Repentance Godhead Godhead: The main tear has the damaging aura as well as the burst tears.
  • Ipecac Ipecac: Tear delay is increased by 1/3 compared to either of the items on their own, but Isaac now fires Ipecac shots that releases poisonous, high-damage but non-explosive split tears on impact.
  • Lachryphagy Lachryphagy: Tears look like Haemolacria. They can be fed and will burst into 8 tears that have Haemolacria's burst effect upon hitting obstacles or enemies.
  • Lead Pencil Lead Pencil/Monstro's Lung Monstro's Lung: Fires a barrage of Haemolacria tears, all of which will burst.
  • Mom's Knife Mom's Knife: Haemolacria tears fire while Mom's Knife is charging.
    • Added in Repentance Mom's Knife overrides Haemolacria tears, but all stat effects from Haemolacria apply.
    • Mom's Knife + Lilith Lilith: Mom's Knife overrides Haemolacria.
  • My Reflection My Reflection: Range becomes extremely high, making Haemolacria tears follow Isaac for a long time before hitting the ground. Burst tears do not have a boomerang effect.
  • Mysterious Liquid Mysterious Liquid: Only the main tear spawns creep.
    • Added in Repentance All tears spawn creep.
  • Technology Technology: Fires arcing tears that release Technology lasers upon bursting.
  • Tech X Tech X: The tears burst into 3-5 Tech X rings on impact.
  • Technology Zero Technology Zero: Main tears and bursts can be connected via electricity.
  • Added in RepentanceTerra Terra: Haemolacria tears have increased knockback and can destroy obstacles.
  • Trisagion Trisagion: Both Trisagion and Haemolacria fire at the same time, Haemolacria does not keep spectral tears despite its tears sprite change but the arced tear keeps piercing.


  • Azazel Azazel: Haemolacria overrides Azazel's Brimstone.
  • Dr. Fetus Dr. Fetus + Sad Bombs Sad Bombs: Bomb explodes into 4 sad bombs which then explode into burst tears.
    • The burst tears themselves create more sad bombs, which leads to an indefinite cascade of explosions. Not recommended unless Isaac has Pyromaniac Pyromaniac or Host Hat Host Hat, as the bombs can damage Isaac.
  • Epic Fetus Epic Fetus: Overrides Haemolacria, with increased damage and tear delay.
  • Flat Stone Flat Stone: At the base range, the main tear bounces once, releasing burst tears which do not bounce, then bursts normally. At a high range, the main tear can bounce multiple times.
  • Holy Light Holy Light: The main tear can be a holy tear and bursts normally in addition to the light beam. Split tears have an independent chance of being holy tears.
  • Kidney Stone Kidney Stone: Overridden by Haemolacria. Only stat changes apply.
    • Added in Repentance Fires a barrage of Haemolacria tears upon activation
  • The Ludovico Technique The Ludovico Technique: Overridden by Haemolacria, provides piercing.
  • Mysterious Liquid Mysterious Liquid: Only the main tear will leave creep.
  • Piercing tears / Spectral tears: The main tear gains these effects, but the burst tears don't inherit them.
  • Polyphemus Polyphemus: The main tear gains the semi-piercing ability and may not burst when hitting a weaker enemy. Split tears do not semi-pierce.
  • Pop! Pop!: Tears no longer arc, but will still burst when hitting an obstacle or stopping and falling to the ground.
  • Sinus Infection Sinus Infection: If the main tear is a booger, it will get stuck and not burst on hitting an enemy, dealing its heightened damage. Split tears have an independent chance of being booger tears.
  • Tractor Beam Tractor Beam: The main tear follows the beam, but the burst spreads normally.

In-game Footage[]



  • Haemolacria was added in Booster Pack #4, after the initial release of the DLC.
  • Haemolacria is based on this Steam Workshop item by HiHowAreYou, originally known as Water Balloon.
  • Haemolacria is a rare condition that causes people to produce tears that are composed of blood.


PC Greed mode only 7RQR CJAB (First floor Golden Treasure Room)

XboxOne Normal mode only JGW6 YMVT

SwitchHard mode only WMAP AJ87 (First floor Treasure Room)

PC Normal and hard modes only L2DY 29AC (Treasure Room adjacent to spawn)


Bug Bug! Removed in Repentance When using The Forgotten's melee attack with both Jacob's Ladder and Haemolacria, the sparks caused by splattered tears will hurt the player. (Video clip)
Bug Bug! Using Mom's Knife and Marked with Haemolacria will cause it to only fire towards the center of room, using the fire buttons will barely move the Marked icon; while Mom's Knife will be unusable and locked to the right.