Little Horn

Effects

(Removed in Repentance) Adds a chance to fire piercing tears which will instantly kill any non-boss enemy.
(Added in Repentance) Adds a chance to fire a tear that summons Big Horn's hand. It will grab and crush any non-boss enemy, killing them instantly, and attacks bosses 3 times for 12 damage each hit (even Big Horn himself).
- Big Horn's hand is able to push projectiles of enemies away from the source of contact. These tears gain additional speed. This makes it especially difficult for the player to dodge while fighting Hush, as it fires a lot of tears and many are propelled by a turning force.
The chance of firing a special tear is 5% at 0 luck and increases to a maximum of 20% with 15 luck.
Running into enemies deals 3.5 damage to them.
- Damage is dealt up to twice per second per enemy.

The special tears will kill some normally invulnerable monsters, such as Death's Heads, Stoneys, and Peep's floating eyeballs.
The special tears can also destroy Blue Fire Places and Purple Fire Places.
The special tears can destroy the various spiked blocks (Wall Hugger, Slide, and Poky) as well as the variants of Stone Grimace. All of these won't respawn if Isaac leaves and re-enters the room.
The contact damage effect overrides the superior contact damage from Aries, The Gamekid, My Little Unicorn / (VII - The Chariot) VII - The Chariot, and The Nail. Only Midas' Touch still works and deals an additional 3.5 damage.

Angelic Prism: Little Horn tears can be split by the prism and will be quadrupled when they pass through it.
Evil Eye: Eyes can fire Little Horn tears. Little Horn tears won't destroy other eyes.
(Added in Repentance) Jacob's Ladder: Enemies hit by Jacob's Ladder's arcs produced by a Little Horn tear will be hit by Big Horn's hand.
Kidney Stone: The stone can have the Little Horn effect.
Soy Milk: Due to its high tear rate, the effect will trigger very often, even with average luck stats.
(Added in Repentance) Saturnus: Little Horn tears can orbit around Isaac upon entering a room.

Brimstone: Overrides Little Horn.
- (Added in Repentance) The laser may trigger the item's effect.
Dr. Fetus / Epic Fetus: Black-tinted bombs can't summon Big Horn's hand to instantly kill non-boss enemies, but it can still be summoned for extra damage against bosses.
Lachryphagy: If Little Horn tears are fed, they will burst into split tears with the same effect. If Little Horn tears feed normal tears, however, the effect is lost.
Mom's Knife: Overrides Little Horn.
- (Added in Repentance) Knife may occasionally trigger the item's effect.
Technology: Overrides Little Horn.
- (Added in Repentance) Occasionally fires a Little Horn laser beam.
Technology Zero: Electricity connected to Little Horn tears will not instantly kill enemies.
Tech X: Overrides Little Horn.
- (Added in Repentance) Occasionally fires a Little Horn laser ring.