20/20

Isaac fires two tears at once, one from each eye.

"Double shot"

• Isaac fires two tears at once, one from each eye.
• -25% damage multiplier.

• 
  Blood Clot - Every second row of tears has increased damage.
• 
  Chemical Peel - Every second row of tears has increased damage.
• 
  Brimstone - Two Brimstone shots are fired, without an increase in charge time.
• 
  Diplopia - Every additional 20/20 adds 2 more tears in a tight pattern.
• 
  Doctor's Remote - Replaces the single missile strike with a barrage of two consecutive missiles.
• 
  Epic Fetus - Replaces the single missile strike with a barrage of two consecutive missiles.
• 
  The Inner Eye - Adds two/three tears to each shot, with no extra fire rate decrease.
• 
  Mutant Spider - Adds two/three tears to each shot, with no extra fire rate decrease.
• 
  The Ludovico Technique - The Ludovico tear gains one smaller tear orbiting the main one, each dealing the same amount of damage.
• 
  Monstro's Lung - Adds two tears to the tear barrage, for a total of 16.
• 
  Sprinkler - Fires two tears at once that almost completely overlap each other.
• 
  Technology - Fires two technology shots simultaneously.
• 
  Tractor Beam - Both tears are fired along the beam. Only one tear can be seen, as they overlap each other.
• 
  The Wiz - Two tears are fired in each direction.

• Treasure Room
• Treasure Room (Greed Mode)