Lead Pencil 
Effects
- After every 15 tears fired, Isaac will fire a low range Monstro's Lung -like barrage of 12 tears.
- (Removed in Repentance) Tears in the barrage deal double damage.
- Tears will fire only from Isaac's right eye.
- (Added in Repentance) Fired tears have a 50% chance to be colored red.
Notes
- Lead Pencil gives characters other than (Cain) Cain the same special properties that he has when it comes to one-eye items like
Blood Clot.
- (Removed in Repentance) Tears fired from items that cause multiple tears to be fired at once e.g.
20/20,
Monstro's Lung, etc. are counted.
Synergies
Compound Fracture/
Cricket's Body/
The Parasite: All tears from the barrage split.
Haemolacria: Fires a barrage of Haemolacria tears, all of which will burst.
Lachryphagy: Tears tend to clump together, becoming one giant tear which splits into 8 large tears. When tears burst, they can also spawn barrages of tears that can be fed.
Pop!: Causes burst tears to remain in the room for much longer, forming a soft barrier of sorts, which enemies must survive through to reach Isaac.
- (Added in Repentance)(Torn Card) Torn Card: Decreases shot requirement by 1. Lead Pencil will fire every 14th shot, with Torn Card quickly following at 15th.
Trisagion: Fires a barrage of beams.
- (Added in Repentance)
The Scooper: All tears benefit from the damage bonus granted by The Scooper.
Interactions
- (Removed in Repentance)
Brimstone: Overrides Lead Pencil.
- (Added in Repentance) The effect from Lead Pencil fires as separate tears from
Brimstone.
Dr. Fetus: Overrides Lead Pencil.
- (Added in Repentance) The Lead Pencil tears fire alongside the bombs.
Epic Fetus: Overrides Lead Pencil.
- (Removed in Repentance) (Lilith) Lilith: No effect, as Lilith is inherently Blindfolded.
- (Added in Repentance) Firing with
Incubus will now activate Lead Pencil.
Loki's Horns: Lead Pencil can fire in any of the cardinal directions if it fires at the same time as Loki's Horns.
- (Removed in Repentance)
The Ludovico Technique: The tear blinks red, but the effect is entirely cosmetic.
- (Added in Repentance) Isaac's body will fire the lead pencil shot toward where the controlled tear is located at a regular time interval
Incubus: Fires red tears like Blood Clot with Cain, but without increased damage.
- (Added in Repentance) Incubus is capable of firing the barrage of tears like Isaac.
- (Removed in Repentance)
Mom's Knife: Overrides Lead Pencil.
- (Added in Repentance) A barrage of tears is fired alongside
Mom's Knife every 15 Knife throws.
- (Removed in Repentance)
Technology: Overrides Lead Pencil.
- (Added in Repentance) A barrage of tears is fired alongside
Technology every 15 shots.
- (Removed in Repentance)
Technology 2: Overrides Lead Pencil and disables normal tears entirely, even if not playing as Cain.
- (Added in Repentance) Replaces tears with lasers similar to Technology. These are shot from the eye that shoots Technology 2, dealing damage alongside the Technology 2 beam.
Tech X: Overrides Lead Pencil.
- (Added in Repentance) Every 15th laser ring fired also shoots a cluster of tears.
Tiny Planet: The burst follows Tiny Planet's circular trajectory with minimal range, hitting the ground almost immediately.