I used to be in the same/similar boat as you when I used to daily drive my old 88 Camaro with the same situation of a retrofitted R12-R134a system that I always felt it just didn't blow hard enough, when in reality it just wasn't blowing cold enough. I got maybe on a good day 55 degrees out of the vents, it blew "cool" but not cold enough to really cool the inside of the car down to make it comfortable. Marginally better than having the windows down, at best.
Okay, so I've got a couple potentially helpful(I hope) suggestions. How deep you go depends on just how cold you'd like to get.
Just to preface, although my truck is a 97 and has a differently designed a/c system than yours, it'll absolutely freeze me out on even the hottest of days.
With your truck being built in 1990, it was designed to run with R12 before it got outlawed in vehicles and converted to the R134a that it's charged with now.
While the conversion to R134a will work fine as it sits, you'll still lose cooling capacity using R12 components.
You're in luck, because GM did update the a/c systems to better handle the R134a.
Hopefully this info can help steer you in the right direction, I'm not sure how compatible all the newer R134a parts are to the older trucks. But it's worth your time to check it out.
1. Condenser.
If the condenser in your truck is original, then there is a huge possibility that it is the older "tube and fin" design and probably pretty crudded up too.
Mild: You could take your grill off and use an appropriate cleaning/foaming solution to clean out much of the crud and gunk in the rad/condenser.
Wild: Do some research and see if you can change the condenser to the one best suited for R134a which is referred to as a "parallel flow" condenser.
2. Clutch fan.
Mild: Double check to make sure that your fan clutch is in good working order, gotta have that airflow.
Wild: You can change your mechanical fan which is most likely the plastic fan, to the heavy duty fan which is made of metal and has more blades for greater airflow.
I believe these came on the 454 and diesel trucks IIRC.
3. Orifice tube.
The one in your truck is likely pretty nasty, and again not best suited for the current refrigerant.
One popular option used as an upgrade/mod across many different vehicles seems to be the "blue" Ford orifice tube. IIRC the OEM application of these were late 90's Thunderbirds.
Also, if you pull the old one out and is really black and nasty then it's time to seriously consider a new compressor and a good flush of the lines/evap core.
4. Receiver/dryer.
Anytime the a/c system is opened up, it's good practice to replace this as there is a desiccant bag inside of it that absorbs contaminants in the a/c system.
It's likely that it's original also. If you're feeling frisky you can even wrap it in insulation and MAY see a slight increase in performance, maybe.
5. Evap.
This one is plain and simple, just make sure that your evap core is clean and doesn't have any leaks.
6. Compressor
Your truck has what is referred to an "R4" type compressor. I can say from first hand experience that these things are J.U.N.K. and have very well known design flaws.
They just don't have the same performance, let alone the reliability of newer compressors.
Mild: If your compressor has ANY signs of the common failure points, strongly consider getting a GOOD quality NEW replacement R4 unit. DO NOT buy ANY re-manufactured compressors... EVER.
Wild: Do some research and upgrade the garbage R4 style compressor to the newer "Sanden" type, similar to what came on newer trucks like mine. There are companies out there on the interwebs that sell parts/kits you can use to retrofit the Sanden compressor on your truck. It'll most likely require the most amount of research/money spent, but in conjunction with everything else listed, you should be able to get your truck into the low 40's. Or even in the 30's like my truck (best measured temp of 39)
Probably worst case scenario, is you may have to have a/c lines made if nothing else is out there that is compatible. If older/newer trucks of our body style had the compressors on the same side it would be even easier to do.
Maybe someone who has done this already will chime in and add some details.
Also, one last thing. If you do change major components to non OEM ones, I would strongly recommend getting a set of manifold gauges and charge the system yourself. Unless you go to a shop that really knows their stuff and is particularly knowledgeable about a/c work, I'd be willing to bet that they'll just charge it with what the book says it should have and send you on your way with a poorly charged system.