The Best Secret Room Items Tier List

S

A

B

C

D

F

S Tier

Death Certificate

A Tier

Glitched Crown, Rock Bottom, Red Key, Eternal D6, Chaos

B Tier

Sacred Orb, R Key, Sausage, Spindown Dice, Lost Contact, Transcendence, D Infinity, Forget Me Now, Blank Card, Pyro, Echo Chamber, Astral Projection, Infamy, We Need to Go Deeper!, Book of Secrets, Odd Mushroom (Large)

C Tier

1up!, Sack Head, Keeper's Sack, Skeleton Key, Rune Bag, Evil Charm, Black Lotus, Dad's Ring, Orphan Socks, Vanishing Twin, Sack of Pennies, Odd Mushroom (Thin), Isaac's Tomb, Spirit Shackles, Mystery Sack, Inner Child, Binge Eater, Eye of Greed, Raw Liver, Mega Mush, Lost Soul, Greed's Gullet

D Tier

Missing No., Mr. Mega, Flip, A Quarter, Clear Rune, Keeper's Box, Cracked Orb, Epic Fetus, GB Bug, Wavy Cap, Cursed Eye, Sack of Sacks, Samson's Chains, Placebo, Strawman, Key Bum, The Necronomicon, Bomb Bag, Esau Jr., Missing Page 2

F Tier

TMTRAINER, Compost, Keeper's Kin