This is a rather casual challenge run. Many of the potential effects of the Rainbow Tears end up being beneficial overall. However, certain tears could temporarily be detrimental, such as Fire Mind tears causing self-damage or Proptosis greatly decreasing range. It is necessary to adapt to the tear trajectories given by Rainbow Worm during the run.
Although you cannot drop the Rainbow Worm, you can still acquire other trinkets through use of a Gulp! pill or any items that allow you to hold two trinkets.