Tears now revolve around Isaac at a fixed distance until they hit the ground.
The tears orbit close to Isaac, offset slightly in the direction fired. Changing the firing direction will redirect all previously fired tears.
Notes
Tears will not hit directly in front of Isaac; aiming directly away from enemies is often effective.
It is possible to control the direction of Tiny Planet with the mouse. On Windows, go to C:/Users/[username]/Documents/My Games/The Binding Of Isaac [Rebirth/Afterbirth/Afterbirth+]/ and in the options.ini file, change the line that says MouseControl=0 to MouseControl=1. Unlike normal controls, the mouse allows diagonal direction.
Synergies
20/20: Each shot fires two tears in opposing orbital directions.
This synergy is effectively the same for The Wiz, with the exception of 20/20's damage penalty not being applied.
Anti-Gravity: Tears orbit around Isaac at a short range while fire button is held. When the fire button is released, tears snap to their normal range.
Azazel: Increases Azazel's range with Brimstone, and wraps the beam around the character.
Brain Worm: Tears will home directly towards nearby enemies in a line from the center of the orbit.
Brimstone: The beam will wrap around the character and shoot straight forward.
Brimstone + Mom's Knife: The knives shot after the Brimstone beam similarly wrap around the character and shoot forward.
Cricket's Body: Tears will split into 2 close groups of 2 tears that follow the orbit. One group travels clockwise and the other travels counterclockwise.
Euthanasia: Euthanasia's tear bursts will follow the orbit in 2 close groups of 5 tears. One group travels clockwise and the other travels counterclockwise.
Eye of Belial: After piercing an enemy, instead of homing in on enemies, tears will continue to orbit, but each tear can pierce multiple enemies to gain more size and damage multipliers.
Eye of the Occult: Tears struggle to move outside of the pre-set path Tiny Planet gives.
Flat Stone: Tears will bounce and orbit around the character.
Godhead: Tears with damaging auras orbit the character, creating a damaging barrier.
Kidney Stone: The stone and barrage of tears that follow orbit the character.
Lachryphagy: Tears will orbit until they are behind the character. Tears will burst into 8 tears that follow the orbit in 2 close groups of 4. One group travels clockwise and the other travels counterclockwise.
Tears orbit the player without slowing down, and can be fed as normal. When a tear bursts, the created tears orbit the place of burst.
Loki's Horns: Effectively grants a great tear multiplier, as the extra tears from Loki's Horns will follow the trajectory given by the Tiny Planet.
Lost Contact: Shielded tears will orbit Isaac, granting a partially successful 360-degree projectile protection around him. Works better with a faster fire rate or Anti-Gravity.
A Lump of Coal: This item drastically increases the screen time of tears because it makes them orbit around Isaac for a few seconds. A Lump Of Coal adds a lot of damage to tears in "outer orbit".
the tears do not fall during the beast fight allowing tears to grow bigger and bigger
Marked: Isaac will continuously fire orbiting tears, which allows him to not touch the attack keys and focus just on moving (with giant tears it makes it hard to see as he can't stop firing).
Mom's Knife: Increases range. Causes Mom's knife to orbit around Isaac at very high speeds until it reaching it's maximum range, where it will circle back to Isaac at the same speed.
My Reflection: After reaching their maximum range, the tears will circle back around to Isaac.
Revelation: The beam of light wraps around Isaac and shoots forward at a slight angle, similar to Brimstone.
Rubber Cement: Tears bounce off enemies then keep orbiting Isaac. Very powerful as the tears are not destroyed upon damaging an enemy. When near walls, the orbiting tears tend to get stuck against the walls until Isaac moves away.
Spirit Sword: The sword's melee attack becomes disjointed from Isaac, hitting in an increased range in front of him but creating a blind spot where the strike used to be. Spin attacks also occur in front of Isaac instead of around him. Sword projectiles orbit around Isaac as normal.
Tainted Eve: Blood clot familiars will each fire tears in their own individual orbits, rather than all orbiting around the character.
Technology: A laser creates a circle around Isaac's body before being fired forward normally. The laser becomes spectral.
Technology + A Lump of Coal: The extra distance covered by the laser more than doubles damage right in front of Isaac, and it increases as normal further away.
Technology Zero: Creates moving laser fields that orbit the character.
Varicose Veins: The ten tears that are fired when the character is hit orbit them closely.
Interactions
Bob's Rotten Head: The thrown bomb orbits around Isaac, making it hard to predict where it will land.
C Section: Fetuses will rotate around Isaac, but still home in on enemies.
Dr. Fetus: The bombs orbit Isaac, exploding just barely far enough to cause no damage assuming he stays motionless.
The Ludovico Technique: Tear orbits around Isaac, however, the orbit can be grown or shrunken, sped up or slowed down by using the firing keys.
Monstro's Lung: This item removes the extra tear falling speed bonus, causing the burst of tears to circle and land behind the player after only being airborne for a short time.
Range isn't as significantly reduced.
My Reflection: Tears will move to maintain their orbital positions around Isaac as he moves, making aiming much easier.
The Parasite: Tears only split when hitting objects and enemies.
A Lump of Coal: Tears glitch out when splitting, remaining for absurdly long times and turning the area around Isaac into an instant-death zone.
Pop!: Tears tend to clump together behind the character and then disappear after a few seconds.
Proptosis: At base damage, tears disappear after half an orbit.
Ring Worm: Every single tear spins uncontrollably fast, making aiming incredibly difficult. However, with large shots (Death's Touch with high damage, for instance) this combo can fill the entire screen with projectiles almost immediately.
Sprinkler: Tears made by Sprinkler will follow Isaac
+7 tear falling speed.
+6.5 range.
20/20: Each shot fires two tears in opposing orbital directions.
The Wiz, with the exception of 20/20's damage penalty not being applied.
Anti-Gravity: Tears orbit around Isaac at a short range while fire button is held. When the fire button is released, tears snap to their normal range.
Azazel: Increases Azazel's range with Brimstone, and wraps the beam around the character.
Brain Worm: Tears will home directly towards nearby enemies in a line from the center of the orbit.
Brimstone: The beam will wrap around the character and shoot straight forward.
Mom's Knife: The knives shot after the Brimstone beam similarly wrap around the character and shoot forward.
Cricket's Body: Tears will split into 2 close groups of 2 tears that follow the orbit. One group travels clockwise and the other travels counterclockwise.
Euthanasia: Euthanasia's tear bursts will follow the orbit in 2 close groups of 5 tears. One group travels clockwise and the other travels counterclockwise.
Eye of Belial: After piercing an enemy, instead of homing in on enemies, tears will continue to orbit, but each tear can pierce multiple enemies to gain more size and damage multipliers.
Eye of the Occult: Tears struggle to move outside of the pre-set path Tiny Planet gives.
Flat Stone: Tears will bounce and orbit around the character.
Godhead: Tears with damaging auras orbit the character, creating a damaging barrier.
Ipecac: Explosive tears orbit around Isaac. 
Host Hat or 
Pyromaniac is highly recommended.
Kidney Stone: The stone and barrage of tears that follow orbit the character.
Lachryphagy: 
Loki's Horns: Effectively grants a great tear multiplier, as the extra tears from Loki's Horns will follow the trajectory given by the Tiny Planet.
Lost Contact: Shielded tears will orbit Isaac, granting a partially successful 360-degree projectile protection around him. Works better with a faster fire rate or 
A Lump of Coal: This item drastically increases the screen time of tears because it makes them orbit around Isaac for a few seconds. A Lump Of Coal adds a lot of damage to tears in "outer orbit".
Marked: Isaac will continuously fire orbiting tears, which allows him to not touch the attack keys and focus just on moving (with giant tears it makes it hard to see as he can't stop firing).
My Reflection: After reaching their maximum range, the tears will circle back around to Isaac.
Revelation: The beam of light wraps around Isaac and shoots forward at a slight angle, similar to Brimstone.
Rubber Cement: Tears bounce off enemies then keep orbiting Isaac. Very powerful as the tears are not destroyed upon damaging an enemy. When near walls, the orbiting tears tend to get stuck against the walls until Isaac moves away.
Spirit Sword: The sword's melee attack becomes disjointed from Isaac, hitting in an increased range in front of him but creating a blind spot where the strike used to be. Spin attacks also occur in front of Isaac instead of around him. Sword projectiles orbit around Isaac as normal.
Tainted Eve: Blood clot familiars will each fire tears in their own individual orbits, rather than all orbiting around the character.
Tainted Lilith: Tears orbit around the 
Gello instead of the character.
Technology: A laser creates a circle around Isaac's body before being fired forward normally. The laser becomes spectral.
Technology Zero: Creates moving laser fields that orbit the character.
Varicose Veins: The ten tears that are fired when the character is hit orbit them closely.
Bob's Rotten Head: The thrown bomb orbits around Isaac, making it hard to predict where it will land.
C Section: Fetuses will rotate around Isaac, but still home in on enemies.
Dr. Fetus: The bombs orbit Isaac, exploding just barely far enough to cause no damage assuming he stays motionless.
Epic Fetus: Overrides Tiny Planet.
Haemolacria: Fired tears orbit around Isaac, but burst tears do not.
Hook Worm: Has no effect.
The Ludovico Technique: Tear orbits around Isaac, however, the orbit can be grown or shrunken, sped up or slowed down by using the firing keys.
Monstro's Lung: This item removes the extra tear falling speed bonus, causing the burst of tears to circle and land behind the player after only being airborne for a short time.
The Parasite: Tears only split when hitting objects and enemies.
Pop!: Tears tend to clump together behind the character and then disappear after a few seconds.
Proptosis: At base damage, tears disappear after half an orbit.
Ring Worm: Every single tear spins uncontrollably fast, making aiming incredibly difficult. However, with large shots (
Death's Touch with high damage, for instance) this combo can fill the entire screen with projectiles almost immediately.
Sprinkler: Tears made by Sprinkler will follow Isaac
Tech X: Overrides Tiny Planet.
Tractor Beam: Overrides Tiny Planet but keeps the large range increase.
Wiggle Worm: The tear forcefully orbits while spiraling. The orbit amplifies the wiggle.
Skatole, tears, and 
The Binding of Isaac: Rebirth
