One particularly ornate type of decorated manuscript was the illuminated manuscript. These manuscripts used gold or silver leaf or powder to create a shiny, luminous effect on the illustrations, which gave the manuscripts a bejewelled quality. Other precious materials, like lapis lazuli and coloured paints made from natural pigments, were also used to decorate illuminated manuscripts.

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Creating an illuminated manuscript was a delicate and highly skilled process. Applying gold leaf, for example, required a great deal of care and precision. The decoration process was usually planned before the text was copied so that the decorator would know where to place illustrations, borders, and other design elements.

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One common way to decorate manuscripts was to incorporate designs into the presentation of initials. Initials could be made larger than other letters and elaborated with pen-work flourishes in red or blue ink. More elaborate initials, called "inhabited initials," contained images of heads or faces of animals or humans, grotesque creatures, or full representations of unknown people, animals, or plants. "Historiated initials" contained narrative scenes or figures drawn from the text, while heraldic devices could be used within initials or as part of the general decorative scheme.

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Overall, manuscript decoration was a complex art form that required a great deal of skill and expertise. It served both aesthetic and functional purposes, making manuscripts, not just beautiful objects, but also useful tools for literacy and understanding.