Leeches are flying monsters introduced in the vanilla content of The Binding of Isaac: Rebirth.
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 a unique type of the Leech with an eye in its mouth. They are introduced in the vanilla content of The Binding of Isaac: Rebirth and commonly found in Sheol but can appear elsewhere such as Necropolis and Dark Room.
These behave similarly to normal Leeches, but explode upon death. They can be spawned by couple of bosses, such as Satan's second form.
Similar to normal Leeches, the Kamikaze Leech and its holy variant is immune to knockback.
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.
Small Leeches are small, juvenile versions of the Leech added in The Binding of Isaac: Repentance DLC.
They are quite similar to normal Leeches and make the same sound effect (albeit higher-pitched), but they do not stop at obstacles and continuously chase Isaac. They are also very small in size and can swim over flooded gaps.
When in a room without water, Small Leeches make small, short hops towards Isaac.
Adult Leeches are bigger and stronger versions of the Leech added in The Binding of Isaac: Repentance DLC.
They are characterized by their large size and much higher amount of health in comparison to typical Leeches. They behave like Leeches but will only charge horizontally and release a ring of 12 blood shots in all directions upon colliding with a wall. Upon taking a certain amount of damage, they burrow underground then reappear by attempting to crash into Isaac from above (a sound cue will play prior to it crashing down) and sending out a ring of 10 blood shots in all directions on impact, which only occurs once per Adult Leech.
- Kamikaze Leech was first added in the Halloween update for the original Flash version of The Binding of Isaac.
- Holy Leech was first added in the original Flash game's Wrath of the Lamb DLC.
- 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.
- Small Leech and Adult Leech first appeared in the fan DLC Antibirth.
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