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For the exception characters that I mentioned, as a general rule, when you have an item that affect only one eye, they have a chance to proc this effect on each of their attacks. For exemple, if Cain would pick up Blood Clot that only affect the left eye, Cain has a 50% chance to proc the effect of Blood Clot, even though he doesn't shoot with his left eye. Azazel and The Forgotten also have a chance to proc such effect on their Brimstone shot or their Melee attack respectively even though they technically don't constitute tears. Both versions of the Keeper will proc such effects on every other of their shots. You can generally observe this in game as items affecting tears from one specific eye also change the appearance of those tears. Blood Clot for exemple shoots slightly bigger blood colored tears.