This article is about the item. For the boss, see Little Horn.
- Adds a chance to fire piercing tears which will instantly kill any non-boss enemy.
- Adds a chance to fire a tear that summons Big Horn's hand. It will grab and crush any non-boss enemy, killing them instantly, and attacks bosses 3 times for 12 damage each hit (even Big Horn himself).
- The chance of firing a special tear is 5% at 0 luck and increases to a maximum of 20% with 15 luck.
- Running into enemies deals 3.5 damage to them.
- Damage is dealt up to twice per second per enemy.
- The special tears will kill some normally invulnerable monsters, such as Death's Heads, Stoneys, and Peep's floating eyeballs.
- The special tears can also destroy Blue Fire Places and Purple Fire Places.
- The special tears can destroy the various spiked blocks (Wall Hugger, Slide, and Poky) as well as the variants of Stone Grimace. All of these won't respawn if Isaac leaves and re-enters the room.
- The contact damage effect overrides the superior contact damage from Aries, The Gamekid, My Little Unicorn / VII - The Chariot, and The Nail. Only Midas' Touch still works and deals an additional 3.5 damage.
- Angelic Prism: Little Horn tears can be split by the prism and will be quadrupled when they pass through it.
- Evil Eye: Eyes can fire Little Horn tears. Little Horn tears won't destroy other eyes.
- Jacob's Ladder: Enemies hit by Jacob's Ladder's arcs produced by a Little Horn tear will be hit by Big Horn's hand.
- Kidney Stone: The stone can have the Little Horn effect.
- Soy Milk: Due to its high tear rate, the effect will trigger very often, even with average luck stats.
- Saturnus: Little Horn tears can orbit around Isaac upon entering a room.
- Brimstone: Overrides Little Horn.
- The laser may trigger the item's effect.
- Dr. Fetus / Epic Fetus: Black-tinted bombs can't summon Big Horn's hand to instantly kill non-boss enemies, but it can still be summoned for extra damage against bosses.
- Lachryphagy: If Little Horn tears are fed, they will burst into split tears with the same effect. If Little Horn tears feed normal tears, however, the effect is lost.
- Mom's Knife: Overrides Little Horn.
- Knife may occasionally trigger the item's effect.
- Technology: Overrides Little Horn.
- Occasionally fires a Little Horn laser beam.
- Technology Zero: Electricity connected to Little Horn tears will not instantly kill enemies.
- Tech X: Overrides Little Horn.
- Occasionally fires a Little Horn laser ring.
- This item might be a reference to Cutaneous horns, unusual keratinous skin tumors with the appearance of horns.
- Little Horn was originally an unofficial item which was supposed to showcase the modding capabilities of Afterbirth+ in the PAX 2016 livestream. However, all items included in the demo were later added to the final game.
- Prior to Repentance, this item's description was "Science!"
- Little Horn's description is a reference to George Orwell's novel Nineteen Eighty-Four.
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