Leeches are flying monsters. Similar to Chargers, if Isaac lines up with a Leech horizontally or vertically, the Leech will quickly charge towards him. Leeches do a full heart of contact damage.
Leeches and their variants are immune to knockback.
Kamikaze Leeches are black Leeches with an eye in its mouth commonly found in Sheol. These behave similarly to Leeches, but explode upon death.
Holy Leeches are white Leeches with an eye in its mouth commonly found in the Cathedral. These behave similarly to Kamikaze Leeches, but have an Eternal Fly circling them. Because the Holy Leech explodes upon death, the Eternal Fly will die instantly and only serves to block projectiles.
Adult Leeches are characterized by their large size and much higher amount of health in comparison to typical Leeches. They behave like Leeches, but releases a ring of blood shots in all directions upon colliding with a wall. They will occasionally burrow into the ground and reappear, either by bursting out of one of the walls closest to Isaac or attempting to crash into Isaac from above and sending out another ring of blood shots on impact.
- The Leech's charging sound effect is, in reality, a man saying "EHHH" sped up. This can be revealed by listening to the attack sound of a Large Champion Leech.
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