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Trisagion is a passive item added in Booster Pack #4.
- Tears are replaced with piercing white blasts of light.
- Blasts deal 33% of regular tear damage, but can hit the same enemy multiple times.
- Blasts do not knock back enemies.
- Brimstone: Overrides Trisagion.
- Dr. Fetus: Overrides Trisagion.
- Epic Fetus: Overrides Trisagion.
- Haemolacria: Functions otherwise as normal, but all blasts deal the same reduced damage.
- Ipecac: Ipecac's damage boost applies; the light beam causes invisible explosions dealing full damage when it impacts something or runs out of range, making it unpredictable and dangerous to use.
- Lachryphagy: The blasts will slow down and float like Lachryphagy tears and eventually burst, but can not consume each other.
- A Lump of Coal: No effect, the blasts' damage is unchanged.
- Mom's Knife: Overrides Trisagion.
- Pop!: The blasts will slow down and float like Pop! tears, but will not bounce off each other.
- Tech X: Overrides Trisagion.
- Technology: Overrides Trisagion.
- Bloodshot Eye: The tears fired from the Bloodshot Eye are replaced with Trisagion tears, even if Trisagion is already overridden by something like Brimstone.
- Godhead: Although the damaging aura isn't visible, it still exists and is not affected by Trisagion's damage reduction.
- Homing tears: The blasts can deal extra damage as they remain in contact with enemies longer.
- The Ludovico Technique: The beam becomes controllable, still dealing reduced damage but at very high rate.
- Proptosis: Base damage is doubled and beam damage is boosted to about 65%. Blasts lose very little power as they travel further.
- Rubber Cement: The blasts still pierce enemies, but bounce off obstacles and walls.
- Trisagion is based on this Steam Workshop item by x Wyvern x.
- The name is a reference to one of the oldest christian hymns.