The Cave Leech is the reason for the long-running informational campaign across all DRG Space Rigs "Look Out, Look Up". It is an immobile, tentacled sack of grease found suspended from secluded ceilings within particularly dark caves, just waiting for anything meaty and unaware to walk past and become an unsuspecting snack. As Ranger Garfax says, says, and says again: "LOOK OUT. LOOK UP."
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~ Miner's Manual Description
Cave Leeches are stationary enemies that spawn in ceilings. They appear as a wide, pink fleshy half-sphere attached to a small crevice in the ceiling, with three small sharp-clawed tentacles for tearing captured prey apart, and one larger central clawed tentacle meant for reaching down and gripping potential prey. The central tentacle has a small bioluminescent bulb in the middle that is visible when reaching down to grab a Dwarf, and can help with spotting it before it grabs you. They generate with the cave while loading a mission, and do not respawn once killed. They generally spawn at a low rate, but their spawn rate is greatly increased by the Cave Leech ClusterMutator.
When a dwarf enters a Cave Leech's range, the central tentacle will extend towards the target at a moderate pace. The attack can be stalled by attacking the claw or the base of the leech. If the claw touches a dwarf, it will pick them up and quickly lift them towards the ceiling. After the claw is fully retracted, the cave leech will begin to use its smaller tentacles to deal short bursts of heavy damage. Unlike a Mactera Grabber, Cave Leeches will not release their target until either the Cave Leech is killed or their target is downed.
Make sure to press the [Shout] key ("X" by default) to shout for help if you are grabbed. This will help your teammates find where you are, or will call Bosco to you.
The Heightened Senses perk is the most useful against Cave Leeches, as they can only be heard when they are close to the player, and can only be properly seen if you’re looking up at the incoming claw, and players can be easily distracted by fighting other creatures. When this perk is equipped, an overlay effect appears at the top of the screen when you are about to be grabbed, which gives you enough warning to look up and shoot at the approaching tentacle to ward it off, or to simply run away. If you manage to get grabbed, you have the option of pressing the [Activate] key ("E" by default) to free yourself, killing the Cave Leech in the process. Note that this action has limited uses (one or two uses depending on the perk tier), so only use it if you know your teammates are too far away to help you (or are downed), or if Bosco is out of revive kits and can't free you before you go down.
Use extreme caution around Cave Leeches if you are the last dwarf standing, as if one successfully attacks you, it is impossible to escape alone (unless you have remaining uses on the aforementioned Heightened Senses perk).
This does not apply to the same degree on Solo missions, because Bosco is easily able to kill Cave Leeches. Remember to get his attention by pressing the [Shout] key ("X" by default) as soon as you are grabbed so that he comes to your aid as fast as possible.
The Scout'sFlare Gun is an extremely useful tool for spotting Cave Leeches, as light from Flares generally cannot reach the high ceilings of some caverns.