The monarch beamed as she undertook the tradition of giving red and white purses containing Maundy money to pensioners, who were chosen in recognition of their service to the community and the Church.
The Queen was joined by the Duke of Edinburgh for the Royal Maundy service, which was held in St George's Chapel at Windsor Castle for the first time since 1959.
The Queen and Duke of Edinburgh leave St George's Chapel at Windsor Castle after the Royal Maundy service
She wore a turquoise wool crepe dress and turquoise tweed coat by Karl Ludwig and a matching hat with a lace trim by Angela Kelly.
The service broke from tradition to mark the Queen's upcoming 90th birthday.
Some 90 men and 90 women received Maundy Money - each coin representing one of the monarch's years - and were selected from across the country, not the local diocese as is usual.
The Queen handed two purses - one white and one red - to each person during a procession of the Chapel, while the choir sang.
Recipients and their guests could be seen wiping away tears after spending a brief moment with the monarch.
The red purse contained a £5 coin commemorating the Queen's 90th birthday and a 50p coin marking the 950th anniversary of the Battle of Hastings, while the white purse contained uniquely minted Maundy coins, equating in pence to her age.
Among the 180 recipients was Tim O'Donovan, 84, who has authored the annual survey of Royal Family engagements published in The Times since 1979.
Mr O'Donovan, who is also a retired lay steward for St George's Chapel, said he began keeping the record "out of curiosity" after thinking "perhaps one should know what the Royal Family are doing".
He said it was a "privilege" and "marvellous" to be part of the service, instead of watching on.
The bells of the Chapel rang out as the Queen's procession, which included the Dean of Windsor, the Right Reverend David David Conner and the Lord High Almoner, the Right Reverend John Inge, left the service.
Excited well-wishers cheered as the group posed on the steps of the Chapel for photos.
The Royal Maundy is an ancient ceremony which originated in the commandment Christ gave after washing the feet of his disciples the day before Good Friday.
It appears to have been custom for members of the Royal Family to take part in the service since the 13th century, the Royal Mint said.
The Queen marked Maundy Thursday by distributing commemorative coins to 90 men and 90 women - each representing one of her 90 years. The 180 recipients of the Maundy money are retired pensioners who were recommended in recognition of their service to the Church and community
The service was held in St George's Chapel at Windsor Castle for the first time since 1959. The Royal Maundy is an ancient ceremony which originated in the commandment Christ gave after washing the feet of his disciples the day before Good Friday.
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