To explore the perceptions of, and barriers to, grey literature searching among medical researchers and journal editors. A cross-sectional survey of authors of systematic reviews and the editors of the journals in which the reviews were published. Systematic reviews indexed in MEDLINE, spanning a 4-week period in 2019. We excluded protocols. We asked whether the reviewers were performing a grey literature search. If they were, we asked about their approach to the grey literature search and relevant guidance. If they were not, we asked about their rationale for this. We elucidated understandings of grey literature from all reviewers. The survey to journal editors asked about their perceptions towards grey literature. A consecutive sample of 1,229 systematic reviews was included. A total of 155 authors responded, and a total of 46 journal editors responded. The majority (57%) of reviewers reported performing a grey literature search. However, there was no consensus on types of grey literature items or sources among the reviewers. The most frequent barrier to grey literature searches was concern about the quality/detail of the grey literature items. Editors expressed negative perceptions towards grey literature, rooted in suspicion of its quality. While many reviewers reported performing a grey literature search, there was a diverse understanding of the term grey literature. Concerns about the quality of grey literature exist among reviewers and editors alike. There is a marked discrepancy between the best-practice guidelines and the gatekeepers of journals.