Can make My Reflection tears much more powerful.IPECAC - Ipecac's long travel time allows for increased damage.Sacred Heart - The slow shot speed and homing can allow for a large damage increase with this item.Magician tarot card or Spoon Bender) and if range has been increased by a large amount. Can be very potent if combined with an item that causes tears to home in on a target (e.g.Turns Mom's Knife black, but does not increase damage.This is because damage increases based on how long Isaac's tears are on screen, and higher Shot Speed decreases that time (not rebirth). Becomes less effective as Shot Speed increases.With Brimstone, Technology or Technology 2 Isaac's damage will increase by 2 instead of the normal effect.
The damage from A Lump of Coal is added when the tear hits, after any damage multipliers.In Rebirth, this is changed so that the tear's damage increases based on its distance from Isaac, an aspect Edmund claims was the original intended use of the item. Already, even without reading it, I can see the parallels between the story and the boy I met. The size of Isaac's tears is decreased initially, but increases as damage does. A story about a man named Abraham getting a message from God to kill his son, Isaac, but is stopped at the last moment by Devine Intervention.
Tears turn black and increases damage based on how long tears have been on the screen. Isaac's face becomes dirtied with coal dust.