Shoots 10 tears in a circle around Isaac, which retain the damage, range, shot speed, and special effects (such as poison) of Isaac's tears. Tears from this item have a +25 flat damage bonus.
When tears hit an object or deplete their range, they spawn 4 smaller tears, whose range and damage scale with Isaac's. Grants -1 tear delay and reduces range. Grants +0.5 fire rate and reduces range.
The first time Isaac takes damage in a room, a familiar leaps on an enemy, dealing damage and releasing a rock wave. For the rest of the room, it chases enemies similar to Dead Bird.
Spawns a controllable Keeper to fight enemies alongside Isaac, functioning similarly to Jacob and Esau. If Keeper dies, he spawns 5 blue spiders and Strawman is removed from Isaac's inventory.