Thanks to the huge damage stat, Isaac can easily reach Boss Rush if reached in time. But while Boss Rush can provide extremely beneficial items, most bosses won't die in a single hit (and damage cannot be increased to one-shot them), resulting in Isaac having to avoid several attacks to fire the next tear. It may be better to skip the Boss Rush to avoid taking unnecessary damage.
Luring enemies into the bouncing tear may be a viable strategy, especially if it is stuck somewhere.
Purposely making the tear stuck (e.g. by shooting it against a wall directly, making it bounce back and forth) might be viable situationally (e.g. Larry Jr. or any fight, where the boss is stationary, especially when this stationary enemy is in the center of the room.
This, or another source of damage, is required when dealing with regenerating enemies, like Globins, as you cannot shot a second tear fast enough before they have regenerated.
Shoop Da Whoop! is a valuable item since its damage scales with Isaac's damage, one-shotting most bosses.
Bob's Rotten Head is also a very strong item because the poison effect deals triple Isaac's damage.
Rotten Baby's blue attack flies give Isaac a more consistent means of dealing damage.
Libra provides one of the only means of overriding this challenge's fixed damage and tears. Of questionable benefit, as it provides resonably high fire rate but rather tame damage. Items that only affect damage or tears (such as Blood of the Martyr or The Sad Onion) apply no change to stats.
Fate's Reward will fire the same high-damage tears at a faster rate than Isaac.
Similarly, Incubus is a very powerful item as it fires an exact copy of the tear essentially doubling the already high damage. Combine this with BFFS! for that tear to become even larger.
Chocolate Milk is an extremely powerful item that will allow Isaac to quickly fire small but powerful tears, or charge up to fire a room size tear that will rapidly bounce off all enemies in the room.
Technology 2 will allow Isaac to fire a very high damage laser without the drawback of the low tear rate.
Succubus is an extremely potent room clearer, since it scales with Isaac's damage.
Finger! scales with Isaac's high starting damage, making this item an effective primary weapon.
Ouroboros Worm can make this run trivial as the tear's high speed and travel rate can have it cover the entire room before it bursts.
Items that give flies or spiders like Guppy's Head or Box of Spiders will be able to near-instantly kill bosses and clear rooms very fast, as flies do two times Isaac's damage.
Eye of Belial grants homing and piercing tears after hitting one enemy.
Circle of Protection is very effective, as its contact damage and deflected tears scale with Isaac's damage. This is especially useful for clearing stragglers.
Brain Worm causes the tear to snap onto enemies even after several bounces.
Mom's Knife should be avoided; despite enormous damage, it will take a long time to charge for any meaningful distance, so Isaac will be essentially reduced to melee range.
Brimstone, Monstro's Lung and Tech X should also be avoided. Although the attack will probably be enough to destroy any enemy or boss, Isaac is defenseless during the lengthy charge time. Tech X also loses the benefit of bouncing attacks.
Ipecac should also be avoided. The tears will not bounce anymore, and due to the great height of the tears, these will pass over the enemies, being very difficult to hit.
Technology should also be avoided, as the delay between lasers will become very long, and the lasers do not bounce.
The Small Rock and Pentagram (if offered by a deal with the Devil) should be avoided; the former will only lower Isaac's speed while the latter will only result in a loss of a Heart container(s).
Proptosis Will lower damage as the tear travels, without any plus to damage.