There are hundreds of unique items that change Isaac’s stats and appearance, often combining in wild, game-breaking ways.

In The Binding of Isaac, players control Isaac as he navigates through a series of increasingly difficult rooms, each filled with enemies, treasures, and obstacles. The game features a variety of power-ups, including items, bombs, and hearts, which can be collected to enhance Isaac's abilities. The game also features a unique "tear" system, where Isaac can shoot tears at enemies to defeat them.