According to the most recent Physician’s Desk Reference, 22 of the top 100 best-selling systemic drugs in the United States have been linked to dry eye. Furthermore, eight of the nine systemic drugs secreted into the tear film have been linked to induce dry eye, including common OTC medications aspirin and ibuprofen. This article will review and provide common examples of many of the medications on this list by class, as well as discuss the mechanism of causation and offer management and treatment approaches.