Adds a chance to fire piercing tears which will instantly kill any non-boss enemy.
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.
Running into enemies deals 3.5 damage to them.
Damage is dealt up to twice per second per enemy.
Notes
The chance to fire special tears depends on the luck stat, and the formula used to determine the chance is:
At base luck (0), the chance is 5%, maxing out at 20% at 15 luck.
The special tears will kill some normally invulnerable monsters, such as Death's Heads, Stoney, and Peep's floating eyeballs.
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.
Black-tinted bombs can summon Big Horn's hand to instantly kill non-boss enemies or to deal 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.
This item might be a reference to Cutaneous horns, unusual keratinous skin tumors with the appearance of horns.
Little Horn was originally an unofficial item which was supposed to showcase the modding capabilities of Afterbirth+ in the PAX 2016 livestream. However, all items included in the demo were later added to the final game.
Prior to Repentance, this item's description was "Science!"
Little Horn's description is a reference to George Orwell's novel Nineteen Eighty-Four.
This may imply that the boss Little Horn is the younger brother of Big Horn.
Little Horn is a reference to the Antichrist in the book of Daniel.
Bugs
Bug!
The item's effect cannot be triggered on Mobile Hosts while they walk.
Adds a chance to fire piercing tears which will instantly kill any non-boss enemy.
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 
Death's Heads, 
Stoney, and 
Peep's floating eyeballs.
Blue Fire Places and 
Purple Fire Places.
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.
Aries, 
The Gamekid, 
My Little Unicorn / 
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.
Brimstone/
Mom's Knife: Each damage tick may trigger Little Horn's effect.
Evil Eye: Eyes can fire Little Horn tears. Little Horn tears won't destroy other eyes.
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.
Saturnus: Little Horn tears can orbit around Isaac upon entering a room.
Tech.5/
Technology/
Tech X: Occasionally fires a Little Horn laser beam.
Technology 2: The laser can also trigger Little Horn’s effect with the laser’s chance to apply the effect being determined rapidly every tick.
Dr. Fetus / 
Epic Fetus: Overrides Little Horn’s tear effects.
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.
Technology Zero: Electricity connected to Little Horn tears will not instantly kill enemies.
Little Horn is the younger brother of 
Bug!
The Binding of Isaac: Rebirth
