This panel presents a solemn hieratic image of the Adoration of Christ. The Virgin Mary, shown with wide staring eyes and larger in scale than the other figures, dominates the composition. The Christ child, held between her legs, makes the gesture of blessing. Beside the Virgin are an angel holding a cross-staff and the three Magi (Wise Men) dressed in Oriental costume – tight trousers, short tunics and Phrygian caps. They present their gifts as sacred offerings with veiled hands.
A narrow panel at the bottom depicts the Nativity. At the left the Virgin reclines on a mattress; on the right the child bound in swaddling clothes appears in a masonry manger surrounded by the traditional symbols of the ox, ass and star of Bethlehem. The woman kneeling before him represents the midwife Salome, a character from the apocryphal (unofficial) gospels.
The formal style and symmetry of the Adoration scene on this ivory may derive from the lost mosaics of the Church of the Nativity in Bethlehem. This presentation anticipates the development of purely devotional images characteristic of later Byzantine art. On the reverse of the ivory are nine lines of a prayer in Greek. It was written in a characteristic twelfth-century hand, indicating the ivory was still in use at that time.