Purpose: The purpose of this study was to evaluate the characteristics of Vogt-Koyanagi-Harada (VKH) disease in elderly (age > or =65 years) Japanese patients., Methods: We reviewed the medical records of all patients diagnosed with VKH disease at the Department of Ophthalmology, Oita University Hospital between October 1982 and March 2005. Data extracted included age, gender, prodromal symptoms, visual acuity, ocular manifestations, extraocular findings, human leukocyte antigen (HLA), ocular complications, treatment, and smoldering inflammation., Results: Of the 68 patients with VKH disease, seven (10%) were classified as elderly at onset. The incidence of optic disk hyperemia, choroidal detachment, and cataract was significantly higher in the elderly patients than the non-elderly patients (<65 years). The total dose of corticosteroid used was higher in the elderly. The incidence of smoldering inflammation was more frequent in the elderly. Final visual acuity was preserved relatively well in the elderly., Conclusion: The significantly higher incidence of optic disk hyperemia, choroidal detachment, and cataract, and the more frequent smoldering inflammation in elderly VKH patients indicate that special attention should be paid to these parameters in elderly patients.