This line follows the pattern of a classic proverb, "None are so blind as those who will not see", but swaps in a new pair of contrasting ideas. The phrase "full of themselves" describes someone who is vain, self-absorbed, and constantly focused on their own importance. The blank needs a word that flips this idea on its head to create irony, since that is how this style of saying always works, by pairing two seemingly opposite states in one sentence.
"Empty" is the correct fit because it directly opposes "full", turning the sentence into a clever observation: people who seem full of pride and self-regard are, in truth, often empty of real depth, wisdom, or humility. This kind of paradox, where a person's outward fullness hides an inward emptiness, is exactly the kind of insight these one-line sayings are built to deliver.
None of the other three words create this effect. "Important", "vital", and "indispensable" all sit on the same side of the meaning spectrum as "full of themselves", describing someone who matters a great deal rather than someone who lacks substance. Using any of them would make the sentence flat and repetitive instead of ironic. Because the sentence depends on a reversal of meaning against "full", and only "empty" supplies that reversal, option 1 is the correct answer.