Tears are smaller and do much less damage, but fire in very rapid succession.
"DMG Down + Tears Way Up"
Reduces tear delay by the formula: (delay / 4) - 2
0.2x damage multiplier.
0.5x tear size multiplier.
Drastically reduces knockback from Isaac's tears.
20/20 - The shot pattern may help in controlling enemy knockback, in addition to dealing up to double damage.
Blood Clot - +1 damage bonus on Blood Clot tears is unaffected by the damage penalty.
Chemical Peel - +2 damage bonus on Chemical Peel tears is unaffected by the damage penalty.
Chocolate Milk - Shots cannot be charged, but Isaac gains a flat +1 damage up after the Soy Milk penalty.
Explosivo - Despite the tiny appearance of the bomb tears, the explosions will do normal explosion damage. Due to the massive fire rate, many bombs can be applied in extremely quick succession, decimating anything after a short delay.
Dr. Fetus - Allows for incredibly fast firing medium damage bombs.
Fires tiny bombs, like the kinds created by Scatter Bombs. Fire rate is unaffected; damage downgrade applies as normal.
Ipecac - The very fast rate of fire fills the screen with low damage explosions.
Libra - Decreases fire rate slightly, but massively increases damage, range, and speed. Tear height is also massively increased, meaning tears can hit enemies through obstacles without spectral effect.
Resets stats to slightly higher than base level
A Lump of Coal - Significantly increases tear damage as they get further away. Even with only this synergy, individual tear damage appears to approach starting tear damage when firing over longer distances.
Mysterious Liquid - Each shot creates creep that deals reasonable damage but stacks with every shot, causing hefty damage.
Pisces - Greatly increases knockback, allowing tears to pin enemies against walls.
Rock Bottom - If Soy Milk is picked up at an opportune time (after Rock Bottom and preferably near the end of the run), it will result in a huge gain in fire rate without the damage penalty.
Technology Zero - The near-constant stream of tears will have electricity chained between them, providing an electrical net of damage making it almost impossible to not hit an enemy. This can greatly help offset the lowered damage by increasing the number of hits.
Tech X - Tech X no longer requires charging and will rapidly fire full-sized laser rings.
Brimstone - Brimstone will fire constantly and can be aimed.
Azazel gains this ability with his low-ranged Brimstone.